Low dosis of alteplase, for ischemic stroke after Enchanted and its determinants, a single center experience

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dc.contributor.authorBrunser, Alejandro
dc.contributor.authorMazzon, Enrico
dc.contributor.authorCavada, Gabriel
dc.contributor.authorMansilla, Eloy
dc.contributor.authorRojo, Alexis
dc.contributor.authorAlmeida, Juan
dc.contributor.authorOlavarría, Verónica
dc.contributor.authorMuñoz Venturelli, Paula
dc.contributor.authorLavados, Pablo
dc.date.accessioned2021-08-20T21:50:00Z
dc.date.available2021-08-20T21:50:00Z
dc.date.issued2020
dc.description.abstractBackground: Low-dose alteplase (LrtPA) has been shown not to be inferior to the standard-dose (SrtPA) with respect to death/disability. Objective: We aim to evaluate the percentage of patients treated with LrtPA at our center after the ENCHANTED trial and the factors associated with the use of this dosage. Methods: Prospective study in consecutive patients with an acute stroke admitted between June 2016 and November 2018. Results: 160 patients were treated with intravenous thrombolysis, 50% female; mean age 65.4±18.5 years. Of these, 48 patients (30%) received LrtPA. In univariate analysis, LrtPA was associated with patient’s age (p=0.000), previous modified Rankin scale scores (mRS) (p<0.000), hypertension (p=0.076), diabetes mellitus (p=0.021), hypercholesterolemia (p=0.19), smoking (p=0.06), atrial fibrillation (p=0.10), history of coronary artery disease (p=0.06), previous treatment with antiplatelet agents (p<0.000), admission International Normalized Ratio-INR (p=0.18), platelet count (p=0.045), leukoaraiosis on neuroimaging (p<0.003), contraindications for thrombolytic treatment (p=0.000) and endovascular treatment (p=0.027). Previous relevant bleedings were determinants for treatment with LrtPA. Final diagnosis on discharge of stroke mimic was significant (p=0.02) for treatment with SrtPA. In multivariate analysis, mRS (OR: 2.21; 95%CI 1.37–14.19), previous antiplatelet therapy (OR: 11.41; 95%CI 3.98–32.70), contraindications for thrombolysis (OR: 56.10; 95%CI 8.81–357.80), leukoaraiosis (OR: 4.41; 95%CI 1.37–14.10) and diagnosis of SM (OR: 0.22; 95%CI 0.10–0.40) remained independently associated. Conclusions: Following the ENCHANTED trial, LrtPA was restricted to 30% of our patients. The criteria that clinicians apply are based mostly on clinical variables that may increase the risk of brain or systemic hemorrhage or exclude the patient from treatment with lytic drugs.es
dc.identifier.citationArquivos de Neuro-Psiquiatria, 2020, vol.78(11):681-686es
dc.identifier.urihttps://doi.org/10.1590/0004-282X20200048es
dc.identifier.urihttp://hdl.handle.net/11447/4417
dc.language.isoenes
dc.titleLow dosis of alteplase, for ischemic stroke after Enchanted and its determinants, a single center experiencees
dc.title.alternativeDosis reducida de alteplase en el accidente cerebrovascular isquémico después del estudio Enchanted y sus determinantes, una experiencia de un solo centroes
dc.typeArticlees

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