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

Detalhes bibliográficos
Autor(a) principal: Brunser,Alejandro Michel
Data de Publicação: 2020
Outros Autores: Mazzon,Enrico, Cavada,Gabriel, Mansilla,Eloy, Rojo,Alexis, Almeida,Juan, Olavarría,Verónica Viviana, Muñoz-Venturelli,Paula, Lavados,Pablo Manuel
Tipo de documento: Artigo
Idioma: eng
Título da fonte: Arquivos de neuro-psiquiatria (Online)
Texto Completo: http://old.scielo.br/scielo.php?script=sci_arttext&pid=S0004-282X2020001100681
Resumo: Abstract Background: 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.
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spelling Low dosis of alteplase, for ischemic stroke after Enchanted and its determinants, a single center experienceAcute StrokeTherapeutic ThrombolysisThrombolytic TherapyAbstract Background: 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.Academia Brasileira de Neurologia - ABNEURO2020-11-01info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersiontext/htmlhttp://old.scielo.br/scielo.php?script=sci_arttext&pid=S0004-282X2020001100681Arquivos de Neuro-Psiquiatria v.78 n.11 2020reponame:Arquivos de neuro-psiquiatria (Online)instname:Academia Brasileira de Neurologiainstacron:ABNEURO10.1590/0004-282x20200048info:eu-repo/semantics/openAccessBrunser,Alejandro MichelMazzon,EnricoCavada,GabrielMansilla,EloyRojo,AlexisAlmeida,JuanOlavarría,Verónica VivianaMuñoz-Venturelli,PaulaLavados,Pablo Manueleng2020-12-16T00:00:00Zoai:scielo:S0004-282X2020001100681Revistahttp://www.scielo.br/anphttps://old.scielo.br/oai/scielo-oai.php||revista.arquivos@abneuro.org1678-42270004-282Xopendoar:2020-12-16T00:00Arquivos de neuro-psiquiatria (Online) - Academia Brasileira de Neurologiafalse
dc.title.none.fl_str_mv Low dosis of alteplase, for ischemic stroke after Enchanted and its determinants, a single center experience
title Low dosis of alteplase, for ischemic stroke after Enchanted and its determinants, a single center experience
spellingShingle Low dosis of alteplase, for ischemic stroke after Enchanted and its determinants, a single center experience
Brunser,Alejandro Michel
Acute Stroke
Therapeutic Thrombolysis
Thrombolytic Therapy
title_short Low dosis of alteplase, for ischemic stroke after Enchanted and its determinants, a single center experience
title_full Low dosis of alteplase, for ischemic stroke after Enchanted and its determinants, a single center experience
title_fullStr Low dosis of alteplase, for ischemic stroke after Enchanted and its determinants, a single center experience
title_full_unstemmed Low dosis of alteplase, for ischemic stroke after Enchanted and its determinants, a single center experience
title_sort Low dosis of alteplase, for ischemic stroke after Enchanted and its determinants, a single center experience
author Brunser,Alejandro Michel
author_facet Brunser,Alejandro Michel
Mazzon,Enrico
Cavada,Gabriel
Mansilla,Eloy
Rojo,Alexis
Almeida,Juan
Olavarría,Verónica Viviana
Muñoz-Venturelli,Paula
Lavados,Pablo Manuel
author_role author
author2 Mazzon,Enrico
Cavada,Gabriel
Mansilla,Eloy
Rojo,Alexis
Almeida,Juan
Olavarría,Verónica Viviana
Muñoz-Venturelli,Paula
Lavados,Pablo Manuel
author2_role author
author
author
author
author
author
author
author
dc.contributor.author.fl_str_mv Brunser,Alejandro Michel
Mazzon,Enrico
Cavada,Gabriel
Mansilla,Eloy
Rojo,Alexis
Almeida,Juan
Olavarría,Verónica Viviana
Muñoz-Venturelli,Paula
Lavados,Pablo Manuel
dc.subject.por.fl_str_mv Acute Stroke
Therapeutic Thrombolysis
Thrombolytic Therapy
topic Acute Stroke
Therapeutic Thrombolysis
Thrombolytic Therapy
description Abstract Background: 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.
publishDate 2020
dc.date.none.fl_str_mv 2020-11-01
dc.type.driver.fl_str_mv info:eu-repo/semantics/article
dc.type.status.fl_str_mv info:eu-repo/semantics/publishedVersion
format article
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dc.identifier.uri.fl_str_mv http://old.scielo.br/scielo.php?script=sci_arttext&pid=S0004-282X2020001100681
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dc.language.iso.fl_str_mv eng
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dc.relation.none.fl_str_mv 10.1590/0004-282x20200048
dc.rights.driver.fl_str_mv info:eu-repo/semantics/openAccess
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dc.publisher.none.fl_str_mv Academia Brasileira de Neurologia - ABNEURO
publisher.none.fl_str_mv Academia Brasileira de Neurologia - ABNEURO
dc.source.none.fl_str_mv Arquivos de Neuro-Psiquiatria v.78 n.11 2020
reponame:Arquivos de neuro-psiquiatria (Online)
instname:Academia Brasileira de Neurologia
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reponame_str Arquivos de neuro-psiquiatria (Online)
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repository.name.fl_str_mv Arquivos de neuro-psiquiatria (Online) - Academia Brasileira de Neurologia
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