Who may benefit from lower dosages of intravenous tissue plasminogen activator? Results from a cluster data analysis  

作　　者：Yi Dong Ye Han Haipeng Shen Yilong Wang Frank Ma Hao Li Yongjun Wang Qiang Dong 

机构地区：[1]Department of Neurology,Huashan Hospital Fudan University,Shanghai,Shanghai,China [2]Department of Business Administration,College of Business,University of Illinois at Urbana-Champaign,Champaign,Illinois,USA [3]Faculty of Business and Economics,University of Hong Kong,Hong Kong,China [4]Department of Neurology,Beijing Tiantan Hospital,Capital Medical University,Beijing,China [5]Medical Research Center,DotHealth,Shanghai,China [6]Big data and AI dempartment,China National Clinical Research Center for Neurological Diseases,Beijing,China

出　　处：《Stroke & Vascular Neurology》2020年第4期348-352,共5页卒中与血管神经病学（英文）

基　　金：The Ministry of Science and Technology Major Project of China(2017YFC1310903);University of Hong Kong BRC Grant,and Patrick SC Poon Professorship Endowment Fund.

摘　　要：background The risk of symptomatic intracranial haemorrhage(sICH)after thrombolysis is low but severe.Lower dose of alteplase may reduce the risk of sICH.We aim to identify subsets of patients who could benefit from lower dose of alteplase compared with standard dose.Methods Data from two observational registries were pooled together.A total of 3479 patients who had acute ischaemic stroke were entered into the interaction tree model.The response variable was the rate of sICH per the definition of the National Institute of Neurological Disorders and Stroke Study.Clinical improvement was measured by the National Institutes of Health Stroke Scale(NIHSS)and defined as NIHSS 0 or 1 or an improvement of more than 4 points(within 7 days or at discharge).Rare event logistic regression was performed to analyse the OR of safety outcome.results To optimise the interaction effect between tissue plasminogen activator(tPA)dosage(standard/lower)and patient subgroups,three subgroups based on the severity of stroke were identified:(1)NIHSS≤4,(2)NIHSS between 5 and 14,and(3)NIHSS≥15.The estimated difference of OR of having sICH was 2.71(95%CI 0.80 to 7.69,p=0.10)for mild,0.13(95%CI 0.02 to 0.68,p=0.01)for moderate,and 0.65(95%CI 0.19 to 2.55,p=0.52)for severe,respectively.In addition,patients who had moderate stroke treated with lower dose had comparable efficacy outcome(OR 1.23,95%CI 0.71 to 2.13,p=0.45).Conclusion Our analysis demonstrated that in patients who had moderate stroke,lower doses of alteplase are associated with significant sICH reduction and non-inferior performance in efficacy,compared with those in the standard dose group.

关 键 词：DOSAGE doses acute 

分 类 号：R741[医药卫生—神经病学与精神病学]