Effectiveness of Standard-Dose vs. Low-Dose Alteplase for Acute Ischemic Stroke Within 3–4.5 h

Chih Hao Chen, Sung Chun Tang, Yu Wei Chen, Chih Hung Chen, Li Kai Tsai, Sheng Feng Sung, Huey Juan Lin, Hung Yu Huang, Helen L. Po, Yu Sun, Po Lin Chen, Lung Chan, Cheng Yu Wei, Jiunn Tay Lee, Cheng Yang Hsieh, Yung Yang Lin, Li Ming Lien, Jiann Shing Jeng

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1 Citation (Scopus)


Background: The efficacy and safety of intravenous alteplase administered 3–4.5 h after acute ischemic stroke have been demonstrated. However, whether responses differ between low-dose and standard-dose alteplase during this time window and whether certain subgroups benefit more remain unknown. Patients and Methods: The current analysis was based on a multicenter matched-cohort study conducted in Taiwan. The treatment group comprised 378 patients receiving intravenous alteplase 3–4.5 h after stroke onset, and the control group comprised 378 age- and sex-matched patients who did not receive alteplase treatment during the same period. Standard- and low-dose alteplase was administered to patients at the physician's discretion. Results: Overall, patients receiving alteplase exhibited more favorable outcomes than did controls [34.0 vs. 22.7%; odds ratio (OR): 1.75, 95% confidence interval (CI): 1.27–1.42], and the effectiveness was consistent in all subgroups. Although patients in the standard-dose group (n = 182) were younger than those in the low-dose (n = 192) group, the proportions of patients with favorable outcomes (36.3 vs. 31.8%; OR: 1.22, 95% CI: 0.80–1.88) and symptomatic hemorrhage (2.8 vs 4.2%; OR: 0.65, 95% CI: 0.21–2.02) were consistently comparable in a covariate-adjusted model and an age-matched cohort. In the subgroup analysis, patients with cardioembolism, atrial fibrillation, and hypercholesterolemia were more likely to achieve favorable outcomes after receiving standard-dose than low-dose alteplase. Conclusion: In the 3–4.5 h time window, the effectiveness and safety of standard-dose and low-dose alteplase may be comparable. A standard dose may be selected for patients with cardioembolism, atrial fibrillation, or hypercholesterolemia.

Original languageEnglish
Article number763963
JournalFrontiers in Neurology
Publication statusPublished - Feb 8 2022


  • alteplase
  • atrial fibrillation
  • hypercholesterolemia
  • rt-PA
  • thrombolysis

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology


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