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Current Neurovascular Research
ISSN (Print): 1567-2026
ISSN (Online): 1875-5739
VOLUME: 11
ISSUE: 1
DOI: 10.2174/1567202610666131126150043









Low-dose Tissue Plasminogen Activator is as Effective as Standard Tissue Plasminogen Activator Administration for the Treatment of Acute Ischemic Stroke

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Author(s): Hui Chen, Guangming Zhu, Nan Liu and Weiwei Zhang
Pages 62-67 (6)
Abstract:
We compared the efficacy of intravenous (IV) combination of low-dose tissue plasminogen activator (tPA) and urokinase (UK) versus either classical IV tPA or UK alone for acute ischemic stroke (AIS) within 4.5 h of symptom onset. One-hundred fifty-three AIS patients were treated with 1 of 3 different IV thrombolytic therapies within a 4.5-h time window. Clinical data included age, gender, type of therapy, NIHSS score, time from onset to needle, ASPECTS, mRS at 90 days, and medical history. The outcomes were ΔNIHSS-a (the difference between NIHSS scores at admission and 24 h); ΔNIHSS-b (difference between NIHSS scores at admission and 7 days), and mRS at 90 days. Multivariate logistic regression (MLR) was used to determine if treatments or other variables could predict these outcomes. Of 153 patients, 60.1% had a good outcome and 39.9% had a poor outcome. The most important predictors of 90-day mRS were AF history (p < 0.001) and NIHSS score at admission (p = 0.001). Age (p = 0.004) and treatment type (p = 0.043) that were also significantly associated with 90-day mRS. IV tPA yielded the best outcome, compared to low-dose tPA/UK (OR = 1.17) and UK alone (OR = 1.42). Low-dose tPA/UK also resulted in better outcome than UK alone did (OR = 1.12). We conclude that low-dose IV tPA with UK administered within a 4.5-h time window was effective and likely comparable to classical IV tPA thrombolysis.
Keywords:
Outcome, Stroke, Thrombolysis, Time window, Tissue-type plasminogen activator, Urokinase.
Affiliation:
Professor of Neurology, Department of Neurology, Military General Hospital of Beijing PLA, 5 Nanmencang, Dongsi, Beijing 100700, China.