Utilization and outcomes with low dose tissue plasminogen activator as intravenous thrombolytic therapy for ischaemic stroke at Aga Khan University Hospital, Karachi: a retrospective analysis. | [Journal of Pakistan Medical Association • 2019]

Author(s):

1. Masood Uz Zaman Babar: Department of Neurology, Aga Khan University Hospital, Karachi, Pakistan

2. Ammar Zaman Khan: Department of general Surgery, Benazir Bhutto Hospital, Rawalpindi, Pakistan

3. Haris Hakim: Department of Neurology, Aga Khan University Hospital, Karachi, Pakistan

4. Jaleed Gilani: Ziauddin Medical College, Karachi, Pakistan

5. Mohammad Wasay: Department of Neurology, Aga Khan University Hospital, Karachi, Pakistan

Abstract:

Objectives: To determine the utilisation of intravenous tissue plasminogen activator at a certain dose for ischaemic stroke thrombolysis and to compare the outcomes with those of a different dosage mentioned in literature. Methods: The retrospective study was conducted at the Aga Khan University Hospital, Karachi, and comprised medical records from January, 2007, to October, 2016, of all patients having received intravenous tissue plasminogen activator for ischaemic stroke thrombolysis. Primary safety outcome variables included symptomatic intracerebral haemorrhage after the start of treatment (0.6mg/kg) and death within three months as per the modified Rankin scale 6. Secondary efficacy outcome variable was functional independence as per modified Rankin scale 0-2 at three months. The outcomes w e r e c om p a r e d w i t h th o s e m e n ti o n e d i n l i te ra tu re w it h a d os e of 0 . 9 m g /k g. Results: Of the 79 patients, 52 (66%) were male and 27 (34 %) were female. Median pre-treatment tissue plasminogen activator score was 12 (interquartile range: 8-15). Overall utilisation of t-PA remained at 1.7%. Symptomatic intracerebral haemorrhage was not seen in our cohort while it was seen in 107 (1.7%) patients at the higher dose. Using another definition, it was seen in 3 (3.8%) patients versus 468 (7.3%) patients at the higher dose. Functional independence was seen in 40 (50.6%) patients at three months compared to 3362 (54.8%) patients at the higher dose. Conclusion: Low-dose intravenous thrombolytic therapy for ischaemic stroke patients was found to be safe and efficacious, and yielded comparable results with those obtained at a higher dose.

Page(s): 1705-1710

DOI: DOI not available

Published: Journal: Journal of Pakistan Medical Association, Volume: 69, Issue: 11, Year: 2019

Keywords:

IV thrombolysis , Low dose , Asians

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