Outcomes of thrombolytic therapy for acute ischemic stroke in Chinese patients: The Taiwan thrombolytic therapy for acute ischemic stroke (TTT-AIS) study

A. Ching Chao, Hung Yi Hsu, Chih Ping Chung, Chung Hsiang Liu, Chih Hung Chen, Michael Mu Huo Teng, Giia Sheun Peng, Wen Yung Sheng, Han Hwa Hu

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Abstract

BACKGROUND AND PURPOSE-: The safety and efficacy of alteplase for ischemic stroke has not been examined in Chinese patients. We assessed the safety and efficacy of alteplase for acute ischemic stroke in daily clinical practice in Taiwan. METHODS-: A prospective, multicenter, observational study was conducted in Taiwan from December 2004 to July 2008. Eligible patients (241) receiving alteplase were recruited and divided into 2 groups: standard dose (0.90±0.02 mg/kg, n=125) and lower dose (0.72±0.07 mg/kg, n=116). Primary outcome measures were safety: symptomatic intracerebral hemorrhage and death within 3 months. The secondary outcome measure was efficacy a modified Rankin scale of 0 to 2 after 3 months. RESULTS-: The standard-dose group had higher rates of symptomatic intracerebral hemorrhage using National Institute of Neurological Diseases and Stroke, European Cooperative Acute Stroke Study, and Safe Implementation of Thrombolysis in Stroke-Monitoring Study definitions (10.4% versus 5.2%, 8.0% versus 2.6%, and 5.6% versus 1.7%, respectively) and mortality within 3 months (12.8% versus 6.9%), twice that of the lower-dose group. This pattern was more prominent in older patients. Significantly higher rates of symptomatic intracerebral hemorrhage per European Cooperative Acute Stroke Study (15.4% versus 3.3%, P=0.0257) and mortality (21.1% versus 5.0%, P=0.0099) and significantly lower independence rate (32.6% versus 53.6%, P=0.0311) were observed among patients â‰170 years old receiving the standard dose than those receiving the lower dose. CONCLUSIONS-: This study suggests that the standard dose of 0.9 mg/kg alteplase may not be optimal for treating aged Chinese patients. However, the dose of recombinant tissue plasminogen activator for ischemic stroke in Chinese patients should be based on more broad and convincing evidences and randomized trials of lower versus higher doses are needed.

Original languageEnglish
Pages (from-to)885-890
Number of pages6
JournalStroke
Volume41
Issue number5
DOIs
Publication statusPublished - May 1 2010
Externally publishedYes

Fingerprint

Thrombolytic Therapy
Taiwan
Tissue Plasminogen Activator
Stroke
Cerebral Hemorrhage
Safety
Outcome Assessment (Health Care)
Mortality
Multicenter Studies
Observational Studies

Keywords

  • Chinese
  • Stroke
  • Thrombolytic therapy

ASJC Scopus subject areas

  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine
  • Advanced and Specialised Nursing

Cite this

Outcomes of thrombolytic therapy for acute ischemic stroke in Chinese patients : The Taiwan thrombolytic therapy for acute ischemic stroke (TTT-AIS) study. / Chao, A. Ching; Hsu, Hung Yi; Chung, Chih Ping; Liu, Chung Hsiang; Chen, Chih Hung; Teng, Michael Mu Huo; Peng, Giia Sheun; Sheng, Wen Yung; Hu, Han Hwa.

In: Stroke, Vol. 41, No. 5, 01.05.2010, p. 885-890.

Research output: Contribution to journalArticle

Chao, A. Ching ; Hsu, Hung Yi ; Chung, Chih Ping ; Liu, Chung Hsiang ; Chen, Chih Hung ; Teng, Michael Mu Huo ; Peng, Giia Sheun ; Sheng, Wen Yung ; Hu, Han Hwa. / Outcomes of thrombolytic therapy for acute ischemic stroke in Chinese patients : The Taiwan thrombolytic therapy for acute ischemic stroke (TTT-AIS) study. In: Stroke. 2010 ; Vol. 41, No. 5. pp. 885-890.
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abstract = "BACKGROUND AND PURPOSE-: The safety and efficacy of alteplase for ischemic stroke has not been examined in Chinese patients. We assessed the safety and efficacy of alteplase for acute ischemic stroke in daily clinical practice in Taiwan. METHODS-: A prospective, multicenter, observational study was conducted in Taiwan from December 2004 to July 2008. Eligible patients (241) receiving alteplase were recruited and divided into 2 groups: standard dose (0.90±0.02 mg/kg, n=125) and lower dose (0.72±0.07 mg/kg, n=116). Primary outcome measures were safety: symptomatic intracerebral hemorrhage and death within 3 months. The secondary outcome measure was efficacy a modified Rankin scale of 0 to 2 after 3 months. RESULTS-: The standard-dose group had higher rates of symptomatic intracerebral hemorrhage using National Institute of Neurological Diseases and Stroke, European Cooperative Acute Stroke Study, and Safe Implementation of Thrombolysis in Stroke-Monitoring Study definitions (10.4{\%} versus 5.2{\%}, 8.0{\%} versus 2.6{\%}, and 5.6{\%} versus 1.7{\%}, respectively) and mortality within 3 months (12.8{\%} versus 6.9{\%}), twice that of the lower-dose group. This pattern was more prominent in older patients. Significantly higher rates of symptomatic intracerebral hemorrhage per European Cooperative Acute Stroke Study (15.4{\%} versus 3.3{\%}, P=0.0257) and mortality (21.1{\%} versus 5.0{\%}, P=0.0099) and significantly lower independence rate (32.6{\%} versus 53.6{\%}, P=0.0311) were observed among patients {\^a}‰170 years old receiving the standard dose than those receiving the lower dose. CONCLUSIONS-: This study suggests that the standard dose of 0.9 mg/kg alteplase may not be optimal for treating aged Chinese patients. However, the dose of recombinant tissue plasminogen activator for ischemic stroke in Chinese patients should be based on more broad and convincing evidences and randomized trials of lower versus higher doses are needed.",
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AU - Hsu, Hung Yi

AU - Chung, Chih Ping

AU - Liu, Chung Hsiang

AU - Chen, Chih Hung

AU - Teng, Michael Mu Huo

AU - Peng, Giia Sheun

AU - Sheng, Wen Yung

AU - Hu, Han Hwa

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N2 - BACKGROUND AND PURPOSE-: The safety and efficacy of alteplase for ischemic stroke has not been examined in Chinese patients. We assessed the safety and efficacy of alteplase for acute ischemic stroke in daily clinical practice in Taiwan. METHODS-: A prospective, multicenter, observational study was conducted in Taiwan from December 2004 to July 2008. Eligible patients (241) receiving alteplase were recruited and divided into 2 groups: standard dose (0.90±0.02 mg/kg, n=125) and lower dose (0.72±0.07 mg/kg, n=116). Primary outcome measures were safety: symptomatic intracerebral hemorrhage and death within 3 months. The secondary outcome measure was efficacy a modified Rankin scale of 0 to 2 after 3 months. RESULTS-: The standard-dose group had higher rates of symptomatic intracerebral hemorrhage using National Institute of Neurological Diseases and Stroke, European Cooperative Acute Stroke Study, and Safe Implementation of Thrombolysis in Stroke-Monitoring Study definitions (10.4% versus 5.2%, 8.0% versus 2.6%, and 5.6% versus 1.7%, respectively) and mortality within 3 months (12.8% versus 6.9%), twice that of the lower-dose group. This pattern was more prominent in older patients. Significantly higher rates of symptomatic intracerebral hemorrhage per European Cooperative Acute Stroke Study (15.4% versus 3.3%, P=0.0257) and mortality (21.1% versus 5.0%, P=0.0099) and significantly lower independence rate (32.6% versus 53.6%, P=0.0311) were observed among patients â‰170 years old receiving the standard dose than those receiving the lower dose. CONCLUSIONS-: This study suggests that the standard dose of 0.9 mg/kg alteplase may not be optimal for treating aged Chinese patients. However, the dose of recombinant tissue plasminogen activator for ischemic stroke in Chinese patients should be based on more broad and convincing evidences and randomized trials of lower versus higher doses are needed.

AB - BACKGROUND AND PURPOSE-: The safety and efficacy of alteplase for ischemic stroke has not been examined in Chinese patients. We assessed the safety and efficacy of alteplase for acute ischemic stroke in daily clinical practice in Taiwan. METHODS-: A prospective, multicenter, observational study was conducted in Taiwan from December 2004 to July 2008. Eligible patients (241) receiving alteplase were recruited and divided into 2 groups: standard dose (0.90±0.02 mg/kg, n=125) and lower dose (0.72±0.07 mg/kg, n=116). Primary outcome measures were safety: symptomatic intracerebral hemorrhage and death within 3 months. The secondary outcome measure was efficacy a modified Rankin scale of 0 to 2 after 3 months. RESULTS-: The standard-dose group had higher rates of symptomatic intracerebral hemorrhage using National Institute of Neurological Diseases and Stroke, European Cooperative Acute Stroke Study, and Safe Implementation of Thrombolysis in Stroke-Monitoring Study definitions (10.4% versus 5.2%, 8.0% versus 2.6%, and 5.6% versus 1.7%, respectively) and mortality within 3 months (12.8% versus 6.9%), twice that of the lower-dose group. This pattern was more prominent in older patients. Significantly higher rates of symptomatic intracerebral hemorrhage per European Cooperative Acute Stroke Study (15.4% versus 3.3%, P=0.0257) and mortality (21.1% versus 5.0%, P=0.0099) and significantly lower independence rate (32.6% versus 53.6%, P=0.0311) were observed among patients â‰170 years old receiving the standard dose than those receiving the lower dose. CONCLUSIONS-: This study suggests that the standard dose of 0.9 mg/kg alteplase may not be optimal for treating aged Chinese patients. However, the dose of recombinant tissue plasminogen activator for ischemic stroke in Chinese patients should be based on more broad and convincing evidences and randomized trials of lower versus higher doses are needed.

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