Low-Dose vs. Standard-Dose Intravenous Alteplase in Bridging Therapy Among Patients With Acute Ischemic Stroke: Experience From a Stroke Center in Vietnam

Duy Ton Mai; Viet Phuong Dao; Van Chi Nguyen; Dang Luu Vu; Tien Dung Nguyen; Xuan Trung Vuong; Quoc Viet Bui; Ha Quan Phan; Quang Tho Pham; Hoang Kien Le; Anh Tuan Tran; Quang Anh Nguyen; Phuc Duc Dang; Hoang Nguyen; Hoang Thi Phan

doi:10.3389/fneur.2021.653820

Low-Dose vs. Standard-Dose Intravenous Alteplase in Bridging Therapy Among Patients With Acute Ischemic Stroke: Experience From a Stroke Center in Vietnam

Front Neurol. 2021 Apr 9:12:653820. doi: 10.3389/fneur.2021.653820. eCollection 2021.

Authors

Duy Ton Mai^{1

2}, Viet Phuong Dao¹, Van Chi Nguyen^{1

2}, Dang Luu Vu^{2

3}, Tien Dung Nguyen¹, Xuan Trung Vuong¹, Quoc Viet Bui¹, Ha Quan Phan¹, Quang Tho Pham¹, Hoang Kien Le³, Anh Tuan Tran³, Quang Anh Nguyen³, Phuc Duc Dang⁴, Hoang Nguyen⁵, Hoang Thi Phan^{1

6}

Affiliations

¹ Stroke Center, Bach Mai Hospital, Ha Noi, Vietnam.
² Department of Emergency and Intensive Care, Ha Noi Medical University, Ha Noi, Vietnam.
³ Radiology Center, Bach Mai Hospital, Ha Noi, Vietnam.
⁴ Stroke Department, The 103 Hospital, Ha Noi, Vietnam.
⁵ Wicking Dementia Research and Education Centre, University of Tasmania, Hobart, TAS, Australia.
⁶ College of Health and Medicine, Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia.

Abstract

Background: To date, the role of bridging intravenous thrombolysis before mechanical thrombectomy (MTE) is controversial but still recommended in eligible patients. Different doses of intravenous alteplase have been used for treating patients with acute ischemic stroke from large-vessel occlusion (LVO-AIS) in Asia, largely due to variations in the risks for intracerebral hemorrhage (ICH) and treatment affordability. Uncertainty exists over the potential benefits of treating low-dose alteplase, as opposed to standard-dose alteplase, prior to MTE among patients with LVO-AIS. Aim: The aim of the study was to compare outcomes of low- vs. standard-dose of bridging intravenous alteplase before MTE among LVO-AIS patients. Methods: We performed a retrospective analysis of LVO-AIS patients who were treated with either 0.6 mg/kg or 0.9 mg/kg alteplase prior to MTE at a stroke center in Northern Vietnam. Multivariable logistic regression models, accounting for potential confounding factors including comorbidities and clinical factors (e.g., stroke severity), were used to compare the outcomes between the two groups. Our primary outcome was functional independence at 90 days following stroke (modified Rankin score; mRS ≤ 2). Secondary outcomes included any ICH incidence, early neurological improvement, recanalization rate, and 90-day mortality. Results: We analyzed data of 107 patients receiving bridging therapy, including 73 with low-dose and 34 with standard-dose alteplase before MTE. There were no statistically significant differences between the two groups in functional independence at 90 days (adjusted OR 1.02, 95% CI 0.29-3.52) after accounting for potential confounding factors. Compared to the standard-dose group, patients with low-dose alteplase before MTE had similar rates of successful recanalization, early neurological improvement, 90-day mortality, and ICH complications. Conclusion: In the present study, patients with low-dose alteplase before MTE were found to achieve comparable clinical outcomes compared to those receiving standard-dose alteplase bridging with MTE. The findings suggest potential benefits of low-dose alteplase in bridging therapy for Asian populations, but this needs to be confirmed by further clinical trials.

Keywords: acute ischemic stroke; alteplase; anterior large artery occlusion; bridging therapy; dose; intravenous thrombolysis; mechanical thrombectomy.