Efficacy and safety analysis of low-dose alteplase in the treatment of acute ischemic stroke

Abstract

Objective To investigate the efficacy and safety of low-dose alteplase in the treatment of patients with mild ischemic stroke. Methods A retrospective collection of 143 patients with mild ischemic stroke [National Institutes of Health Stroke Scale (NIHSS) score ≤ 5 points] in Leshan People's Hospital within 4.5 hours of onset from November 2017 to January 2022 was collected. Cases were divided into low-dose group (49 cases), standard-dose group (46 cases) and control group (48 cases) according to the treatment method. Patients in the low-dose group received intravenous thrombolysis with alteplase (0.6 mg/kg) within 4.5 hours of onset, and if there was no hemorrhagic transformation after 24 hours, dual-antibody therapy was used for 21 days; patients in the standard-dose group received alteplase within 4.5 hours Enzyme (0.9 mg/kg) was used for intravenous thrombolysis, and the follow-up antithrombotic regimen was the same as that of the low-dose group; the control group received double-antibody therapy for 21 days immediately after admission. The 24-hour and 7-day NIHSS scores of the three groups were compared with the baseline levels; the 24-hour NIHSS scores, the 7-day NIHSS scores, and the proportions of good functional outcome, mild disability, and moderate to severe disability were compared among the three groups of patients The incidence of hemorrhage events within 36 hours, and the mortality rate at 7 days and 90 days were compared among the three groups. Results The NIHSS scores of the low-dose group and the standard-dose group 24 hours after treatment, and the NIHSS scores of the three groups at 7 days were all lower than the baseline level, and the difference was statistically significant (P<0.05). There was no significant difference in 24-hour NIHSS scores among the three groups (P>0.05). The 7-day NIHSS scores of the low-dose group and the standard-dose group were lower than those of the control group, and the difference was statistically significant (P<0.05); there was no significant difference between the 7-day NIHSS scores of the low-dose group and the standard-dose group (P>0.05) . There was no significant difference in the 90-day good functional outcome, mild disability, and moderate to severe disability among the three groups (P>0.05). In terms of safety, there was no significant difference in the incidence of various types of bleeding between the low-dose group and the standard-dose group, and between the low-dose and the control group (P>0.05); There was statistical significance (P<0.05); there was no significant difference in the incidence of other types of bleeding between the two groups (P>0.05). There was no significant difference in the 7-day and 90-day mortality among the three groups (P>0.05). Conclusion Low-dose alteplase may accelerate the recovery of symptoms in patients with mild ischemic stroke, which is similar to standard-dose alteplase, without significantly increasing the risk of bleeding and death. [International Journal of Neurology Neurosurgery, 2022, 49(6):7-12]