title: Current status of intravenous thrombolysis for acute ischemic stroke in Asia.
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.
  
  
  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.
  
  
  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.
  
  
  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.
authors: Division of Neurology, National University Hospital, Singapore, Singapore. drvijay@singnet.com.sg
authors: Vijay K
authors: VK
authors: Sharma
authors: Kay W P
authors: KW
authors: Ng
authors: Narayanaswamy
authors: N
authors: Venketasubramanian
authors: Maher
authors: M
authors: Saqqur
authors: Hock L
authors: HL
authors: Teoh
authors: Subash
authors: S
authors: Kaul
authors: Padma M V
authors: PM
authors: Srivastava
authors: Theodoris
authors: T
authors: Sergentanis
authors: Nijasri
authors: N
authors: Suwanwela
authors: Thang H
authors: TH
authors: Nguyen
authors: K S
authors: KS
authors: Lawrence Wong
authors: Bernard P L
authors: BP
authors: Chan
mesh_terms: D000368:Aged; D001208:Asia / Q000453:epidemiology; D002545:Brain Ischemia / Q000150:complications / Q000188:drug therapy*; D016001:Confidence Intervals; D003627:Data Interpretation, Statistical; D004305:Dose-Response Relationship, Drug; D005006:Ethnicity; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D007275:Injections, Intravenous; D007564:Japan; D008297:Male; D008875:Middle Aged; D015337:Multicenter Studies as Topic; D012042:Registries; D018570:Risk Assessment; D020521:Stroke / Q000188:drug therapy* / Q000209:etiology; D015912:Thrombolytic Therapy / Q000009:adverse effects / Q000639:trends*; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator