title: Outcome of intravenous thrombolysis in stroke patients weighing over 100 kg.
abstract: BACKGROUND
  Intravenous thrombolysis with alteplase for ischemic stroke is fixed at a maximal dose of 90 mg for safety reasons. Little is known about the clinical outcomes of stroke patients weighing >100 kg, who may benefit less from thrombolysis due to this dose limitation.
  
  
  METHODS
  Prospective data on 1,479 consecutive stroke patients treated with intravenous alteplase in six Swiss stroke units were analyzed. Presenting characteristics and the frequency of favorable outcomes, defined as a modified Rankin scale (mRS) score of 0 or 1, a good outcome (mRS score 0-2), mortality and symptomatic intracranial hemorrhage (SICH) were compared between patients weighing >100 kg and those weighing ≤100 kg.
  
  
  RESULTS
  Compared to their counterparts (n = 1,384, mean body weight 73 kg), patients weighing >100 kg (n = 95, mean body weight 108 kg) were younger (61 vs. 67 years, p < 0.001), were more frequently males (83 vs. 60%, p < 0.001) and more frequently suffered from diabetes mellitus (30 vs. 13%, p < 0.001). As compared with patients weighing ≤100 kg, patients weighing >100 kg had similar rates of favorable outcomes (45 vs. 48%, p = 0.656), good outcomes (58 vs. 64%, p = 0.270) and mortality (17 vs. 12%, p = 0.196), and SICH risk (1 vs. 5%, p = 0.182). After multivariable adjustment, body weight >100 kg was strongly associated with mortality (p = 0.007) and poor outcome (p = 0.007).
  
  
  CONCLUSIONS
  Our data do not suggest a reduced likehood of favorable outcomes in patients weighing >100 kg treated with the current dose regimen. The association of body weight >100 kg with mortality and poor outcome, however, demands further large-scale studies to replicate our findings and to explore the underlying mechanisms.
authors.affiliation: Department of Neurology, University Hospital of Zurich, Zurich, Switzerland. hakan.sarikaya@usz.ch
authors.forename: H
authors.initials: H
authors.lastname: Sarikaya
authors.forename: M
authors.initials: M
authors.lastname: Arnold
authors.forename: S T
authors.initials: ST
authors.lastname: Engelter
authors.forename: P A
authors.initials: PA
authors.lastname: Lyrer
authors.forename: H P
authors.initials: HP
authors.lastname: Mattle
authors.forename: P
authors.initials: P
authors.lastname: Michel
authors.forename: C
authors.initials: C
authors.lastname: Odier
authors.forename: B
authors.initials: B
authors.lastname: Weder
authors.forename: P
authors.initials: P
authors.lastname: Siebel
authors.forename: F
authors.initials: F
authors.lastname: Mueller
authors.forename: P
authors.initials: P
authors.lastname: Ballinari
authors.forename: D
authors.initials: D
authors.lastname: Georgiadis
authors.forename: R W
authors.initials: RW
authors.lastname: Baumgartner
mesh_terms: D000368:Aged; D001835:Body Weight; D016009:Chi-Square Distribution; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D007262:Infusions, Intravenous; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications* / Q000175:diagnosis / Q000401:mortality; D016017:Odds Ratio; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D020521:Stroke / Q000150:complications / Q000188:drug therapy* / Q000401:mortality; D013557:Switzerland; D015912:Thrombolytic Therapy / Q000009:adverse effects / Q000401:mortality; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage* / Q000009:adverse effects; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator