Back to Search
Start Over
Current status of intravenous thrombolysis for acute ischemic stroke in Asia.
- Source :
-
International journal of stroke : official journal of the International Stroke Society [Int J Stroke] 2011 Dec; Vol. 6 (6), pp. 523-30. - Publication Year :
- 2011
-
Abstract
- Background: Data regarding thrombolysis for acute ischemic stroke in Asia are scarce and only a small percentage of patients are thrombolysed. The dose of intravenous tissue plasminogen activator (IV-tPA) in Asia remains controversial. Case-controlled observation studies in Asia included only Japanese patients and suggested the clinical efficacy and safety of low-dose IV-tPA (0.6 mg/kg body weight; max 60 mg) comparable to standard dose (0.9 mg/kg body weight; max. 90 mg). Reduced treatment cost, lower symptomatic intracerebral hemorrhage risk and comparable efficacy encouraged many Asian centers to adopt low-dose or even variable-dose IV-tPA regimens. We evaluated various Asian thrombolysis studies and compared with SITS-MOST registry and NINDS trial.<br />Methods: We included the published studies on acute ischemic stroke thrombolysis in Asia. Unadjusted relative risks and 95% Confidence intervals were calculated for each study. Pooled estimates from random effects models were used because the tests for heterogeneity were significant.<br />Results: We found only 18 publications regarding acute ischemic stroke thrombolysis in Asia that included total of 9300 patients. Owing to ethnic differences, stroke severity, small number of cases in individual reports, outcome measures and tPA dose regimes, it is difficult to compare these studies. Functional outcomes were almost similar (to Japanese studies) when lower-dose IV-tPA was used in non-Japanese populations across Asia. Interestingly, with standard dose IV-tPA, considerably better functional outcomes were observed, without increasing symptomatic intracerebral hemorrhage rates.<br />Conclusions: Variable dose regimens of IV-tPA are used across Asia without any reliable or established evidence. Establishing a uniform IV-tPA regimen is essential since the rapid improvements in health-care facilities and public awareness are expected to increase the rates of thrombolysis in Asia.<br /> (© 2011 The Authors. International Journal of Stroke © 2011 World Stroke Organization.)
- Subjects :
- Aged
Asia epidemiology
Brain Ischemia complications
Confidence Intervals
Data Interpretation, Statistical
Dose-Response Relationship, Drug
Ethnicity
Female
Fibrinolytic Agents adverse effects
Humans
Injections, Intravenous
Japan
Male
Middle Aged
Multicenter Studies as Topic
Registries
Risk Assessment
Stroke etiology
Thrombolytic Therapy adverse effects
Tissue Plasminogen Activator administration & dosage
Tissue Plasminogen Activator therapeutic use
Treatment Outcome
Brain Ischemia drug therapy
Fibrinolytic Agents administration & dosage
Fibrinolytic Agents therapeutic use
Stroke drug therapy
Thrombolytic Therapy trends
Subjects
Details
- Language :
- English
- ISSN :
- 1747-4949
- Volume :
- 6
- Issue :
- 6
- Database :
- MEDLINE
- Journal :
- International journal of stroke : official journal of the International Stroke Society
- Publication Type :
- Academic Journal
- Accession number :
- 22111797
- Full Text :
- https://doi.org/10.1111/j.1747-4949.2011.00671.x