Low-Dose versus Standard-Dose Alteplase in Bridging Therapy for Large Vessel Stroke: A Systematic Review and...

Area of Science:

• Neurology
• Cardiovascular Medicine
• Pharmacology

Background:

• Efficacy and safety of low- vs. standard-dose alteplase for acute ischemic stroke (AIS) remain inconsistently compared.
• Further exploration is needed for low- vs. standard-dose alteplase in bridging therapy (BT) for large vessel occlusion (LVO).
• This study compared clinical outcomes of BT with low- and standard-dose alteplase in LVO-related AIS patients.

Approach:

• Systematic literature search of RCTs and cohort studies in PubMed, Embase, and Cochrane Library (up to Nov 2022).
• Compared 90-day functional independence, successful recanalization, symptomatic intracerebral hemorrhage (sICH), and mortality between low-dose (0.6 mg/kg) and standard-dose (0.9 mg/kg) alteplase BT.
• Performed meta-analysis and ethnicity-based subgroup analysis (Asian and non-Asian).

Key Points:

• Meta-analysis of 5 observational studies (408 patients) found low-dose alteplase BT did not improve 90-day functional independence compared to standard-dose.
• Low-dose alteplase BT showed comparable rates of successful recanalization, sICH incidence, and mortality, though these differences were not statistically significant.
• Ethnicity-based subgroup analyses revealed no significant differences between Asian and non-Asian participants.

Conclusions:

• BT with low- or standard-dose alteplase may offer similar efficacy in LVO-related AIS patients.
• No significant differences were found in sICH incidence and mortality between the two doses.
• Well-designed prospective studies are needed to confirm these findings.