Department of Neurology, Fujian Provincial Hospital South Branch, Fuzhou, China.
Department of Neurology, Longyan First Hospital of Fujian Medical University, Longyan, Fujian, China.
Int J Med Sci. 2022 Oct 3;19(12):1762-1769. doi: 10.7150/ijms.76105. eCollection 2022.
Factors for the utilization of intravenous thrombolysis with a low-dose of alteplase (0.6mg/kg) and whether the low-dose of alteplase could reduce the risk of intracerebral bleeding in acute ischemic stroke (AIS) remains uncertain. We aimed to investigate determinants for the utilization of intravenous thrombolysis with a low-dose of alteplase. We further assessed the association between the low-dose of alteplase and the intracerebral bleeding risk in AIS patients. We included AIS patients who received intravenous thrombolysis using alteplase in this multicenter retrospective observational study. We investigated the association between baseline characteristics and the utilization of a low-dose of alteplase to identify determinants. We assessed the association of the low-dose of alteplase with the risk of symptomatic intracranial hemorrhage (sICH) using a multivariable logistic regression model. We further compared the rate of sICH and any ICH in patients in the low-dose group to those in the standard-dose group, using propensity score-matching data. A total of 506 AIS patients were included in this study. The mean age was 67 (interquartile range [IQR] 59-75), and 178 (35.2%) were women. A total of 96 patients were treated with the low-dose. Age (adjusted odds ratio [OR] 1.02, 95% confidence interval [CI] 1.00 -1.04, p = 0.042), having a previous ischemic stroke (adjusted OR 2.01, 95%CI 1.11 - 3.64 p = 0.021) and increasing baseline systolic blood pressure (adjusted OR 1.12, 95%CI 1.00 - 1.26, p = 0.049) were determinants for the utilization of the low-dose. Multivariable logistic regression analysis showed that the low-dose was significantly associated with a reduced risk of sICH (adjusted OR 0.13, 95%CI 0.03 - 0.62, p = 0.01). Propensity score analysis showed that the rate of sICH was significantly lower in the low-dose group compared to standard-dose group (2 [2.3%] vs 10 [11.4%], p = 0.032). There was no significant difference in the rate of any ICH between two groups (14 [15.9%] vs 18 [20.5%], p = 0.434). Patients with increasing age, a higher baseline systolic blood pressure, and previous ischemic stroke were at a higher odd of receiving a low-dose of alteplase. The low-dose was associated with a lower risk of developing symptomatic intracranial hemorrhage.
低剂量阿替普酶（0.6mg/kg）静脉溶栓的应用因素以及低剂量阿替普酶是否能降低急性缺血性脑卒中（AIS）患者颅内出血的风险仍不确定。本研究旨在探讨低剂量阿替普酶静脉溶栓的应用因素，并进一步评估低剂量阿替普酶与 AIS 患者颅内出血风险之间的关系。
本研究纳入了接受阿替普酶静脉溶栓治疗的 AIS 患者。我们研究了基线特征与低剂量阿替普酶应用之间的关系，以确定应用因素。我们使用多变量逻辑回归模型评估低剂量阿替普酶与症状性颅内出血（sICH）风险之间的关系。我们进一步使用倾向评分匹配数据比较了低剂量组和标准剂量组患者 sICH 和任何 ICH 的发生率。
本研究共纳入 506 例 AIS 患者，平均年龄为 67 岁（四分位距 [IQR] 59-75），178 例（35.2%）为女性。共有 96 例患者接受了低剂量治疗。年龄（调整后优势比 [OR] 1.02，95%置信区间 [CI] 1.00-1.04，p=0.042）、既往缺血性脑卒中（调整后 OR 2.01，95%CI 1.11-3.64，p=0.021）和基线收缩压升高（调整后 OR 1.12，95%CI 1.00-1.26，p=0.049）是低剂量应用的决定因素。多变量逻辑回归分析显示，低剂量与 sICH 风险降低显著相关（调整后 OR 0.13，95%CI 0.03-0.62，p=0.01）。倾向评分分析显示，低剂量组 sICH 发生率明显低于标准剂量组（2[2.3%] vs 10[11.4%]，p=0.032）。两组任何 ICH 发生率无显著差异（14[15.9%] vs 18[20.5%]，p=0.434）。
基线收缩压升高、年龄较大和既往缺血性脑卒中的患者接受低剂量阿替普酶的可能性更高。低剂量与发生症状性颅内出血的风险降低相关。
