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Low- versus standard-dose alteplase in patients on prior antiplatelet therapy: the ENCHANTED trial (enhanced control of hypertension and thrombolysis stroke study)

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dc.contributor.author Robinson, Thompson G.
dc.contributor.author Wang, Xia
dc.contributor.author Arima, Hisatomi
dc.contributor.author Bath, Philip
dc.contributor.author Billot, Laurent
dc.contributor.author Broderick, Joseph P.
dc.contributor.author Demchuk, Andrew M.
dc.contributor.author Donnan, Geoffery A.
dc.contributor.author Kim, Jong S.
dc.contributor.author Lavados, Pablo
dc.contributor.author Lee, Tsong-Hai
dc.contributor.author Lindley, Richard I.
dc.contributor.author Martins, Sheila C. O.
dc.contributor.author Olavarria, Veronica V.
dc.contributor.author Pandian, Jeyaraj D.
dc.contributor.author Parsons, Mark W.
dc.contributor.author Pontes-Neto, Octavio M.
dc.contributor.author Ricci, Stefano
dc.contributor.author Sato, Shoichiro
dc.contributor.author Sharma, Vijay K.
dc.contributor.author Nguyen, Thang H.
dc.contributor.author Wang, Ji-Guang
dc.contributor.author Woodward, Mark
dc.contributor.author Chalmers, John
dc.contributor.author Anderson, Craig
dc.contributor.author ENCHANTED Investigators
dc.date.accessioned 2017-09-12T13:04:14Z
dc.date.available 2017-09-12T13:04:14Z
dc.date.issued 2017
dc.identifier.citation Stroke. 2017 Jul;48(7):1877-1883 es_CL
dc.identifier.uri http://dx.doi.org/10.1161/STROKEAHA.116.016274 es_CL
dc.identifier.uri http://hdl.handle.net/11447/1677
dc.description.abstract BACKGROUND AND PURPOSE: Many patients receiving thrombolysis for acute ischemic stroke are on prior antiplatelet therapy (APT), which may increase symptomatic intracerebral hemorrhage risk. In a prespecified subgroup analysis, we report comparative effects of different doses of intravenous alteplase according to prior APT use among participants of the international multicenter ENCHANTED study (Enhanced Control of Hypertension and Thrombolysis Stroke Study). METHODS: Among 3285 alteplase-treated patients (mean age, 66.6 years; 38% women) randomly assigned to low-dose (0.6 mg/kg) or standard-dose (0.9 mg/kg) intravenous alteplase within 4.5 hours of symptom onset, 752 (22.9%) reported prior APT use. Primary outcome at 90 days was the combined end point of death or disability (modified Rankin Scale [mRS] scores, 2-6). Other outcomes included mRS scores 3 to 6, ordinal mRS shift, and symptomatic intracerebral hemorrhage by various standard criteria. RESULTS: There were no significant differences in outcome between patients with and without prior APT after adjustment for baseline characteristics and management factors during the first week; defined by mRS scores 2 to 6 (adjusted odds ratio [OR], 1.01; 95% confidence interval [CI], 0.81-1.26; P=0.953), 3 to 6 (OR, 0.95; 95% CI, 0.75-1.20; P=0.662), or ordinal mRS shift (OR, 1.03; 95% CI, 0.87-1.21; P=0.770). Alteplase-treated patients on prior APT had higher symptomatic intracerebral hemorrhage (OR, 1.82; 95% CI, 1.00-3.30; P=0.051) according to the safe implementation of thrombolysis in stroke-monitoring study definition. Although not significant (P-trend, 0.053), low-dose alteplase tended to have better outcomes than standard-dose alteplase in those on prior APT compared with those not using APT (mRS scores of 2-6; OR, 0.84; 95% CI, 0.62-1.12 versus OR, 1.16; 95% CI, 0.99-1.36). CONCLUSIONS: Low-dose alteplase may improve outcomes in thrombolysis-treated acute ischemic stroke patients on prior APT, but this requires further evaluation in a randomized controlled trial. es_CL
dc.format.extent 7 es_CL
dc.language.iso en_US es_CL
dc.publisher American Heart Association es_CL
dc.subject aspirin es_CL
dc.subject brain infarction es_CL
dc.subject hypertension es_CL
dc.subject intracranial hemorrhages es_CL
dc.subject tissue plasminogen activator es_CL
dc.title Low- versus standard-dose alteplase in patients on prior antiplatelet therapy: the ENCHANTED trial (enhanced control of hypertension and thrombolysis stroke study) es_CL
dc.type Artículo es_CL


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