title: Safety of high doses of urokinase and reteplase for acute ischemic stroke.
abstract: OBJECTIVE
  ET is considered in selected patients with AIS with persistent arterial occlusion after receiving IVT. Limited data exist on the safety of IA high doses of UK and RT for ET. We investigated any correlation between IA doses of UK or RT and safety outcomes in patients who underwent ET.
  
  
  METHODS
  We identified all patients from our stroke registry who received UK or RT for ET from 1998 to 2008. Demographics, baseline National Institutes of Health Stroke Scale scores, recanalization rates, rates of attempted MT, mortality, SICH, and discharge modified Rankin Scale scores were collected.
  
  
  RESULTS
  Of 197 patients; 72 received UK and 125 received RT. More than 90% of patients in both groups had received prior IVT. The median IA dose of UK was 200,000 U (range, 25,000-1,500,000 U) and of RT was 2 mg (range, 1-8 mg). Concurrent MT was attempted in 59.7% of UK-treated patients and 72.0% of RT-treated patients, with SICH rates of 4.2% and 8.0%, respectively. Logistic regression adjusting for prior IVT and MT revealed no correlation between SICH and doses of UK (OR, 1.00; 95% CI, 0.99-1.00; P = .94) or RT (OR, 0.803; 95% CI, 0.48-1.33; P = .39). There was no correlation between mortality and doses of UK (OR, 1.00; 95% CI, 0.99-1.00; P = .51) or RT (OR, 1.048; 95% CI, 0.77-1.42; P = .75).
  
  
  CONCLUSIONS
  High IA doses of UK and RT may be safe when given with or without MT in patients with AIS despite receiving a full dose of intravenous recombinant tissue plasminogen activator. These results need prospective validation.
authors.affiliation: Department of Neurology, The University of Texas Medical School at Houston, USA.
authors.forename: V
authors.initials: V
authors.lastname: Misra
authors.forename: R
authors.initials: R
authors.lastname: El Khoury
authors.forename: R
authors.initials: R
authors.lastname: Arora
authors.forename: P R
authors.initials: PR
authors.lastname: Chen
authors.forename: S
authors.initials: S
authors.lastname: Suzuki
authors.forename: N
authors.initials: N
authors.lastname: Harun
authors.forename: N R
authors.initials: NR
authors.lastname: Gonzales
authors.forename: A D
authors.initials: AD
authors.lastname: Barreto
authors.forename: J C
authors.initials: JC
authors.lastname: Grotta
authors.forename: S I
authors.initials: SI
authors.lastname: Savitz
mesh_terms: D015897:Comorbidity; D004305:Dose-Response Relationship, Drug; D064420:Drug-Related Side Effects and Adverse Reactions / Q000453:epidemiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011994:Recombinant Proteins / Q000627:therapeutic use; D018570:Risk Assessment; D012307:Risk Factors; D020521:Stroke / Q000188:drug therapy* / Q000453:epidemiology*; D013781:Texas / Q000453:epidemiology; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*; D014568:Urokinase-Type Plasminogen Activator / Q000627:therapeutic use*
chemical_list: D011994:Recombinant Proteins; C087896:reteplase; D010959:Tissue Plasminogen Activator; D014568:Urokinase-Type Plasminogen Activator