title: Dosing of tissue plasminogen activator often differs from 0.9 mg/kg, but does not affect the outcome.
abstract: BACKGROUND
  The safety and efficacy of low- and high-dose intravenous tissue plasminogen activator (t-PA) for the treatment of acute ischemic stroke are poorly understood. In this multicenter study, we examined the relationships between different doses of t-PA and outcome.
  
  
  METHODS
  Between 2006 and 2010, patients were enrolled if they were treated with t-PA on the basis of estimated body weight and on the subsequent availability of actual body weight. Based on the actual weight, patients were divided into lower (<0.85 mg/kg), standard (0.85-0.95 mg/kg), and higher (>0.95 mg/kg) t-PA dose groups. Differences in the outcomes of these groups were compared in terms of functional recovery (modified Rankin Scale [mRS] 0-1) at 3 months and the incidence of parenchymal hemorrhages on follow-up computed tomographic scans.
  
  
  RESULTS
  This cohort study included 272 patients: 171 (63%) patients received the standard t-PA dose, 62 (23%) a lower dose, and 39 (14%) a higher dose. At 3 months, 51% of the standard dose patients achieved a mRS score of 0 to 1, compared with 50% in the lower dose and 44% in the higher dose groups. Parenchymal hemorrhage occurred in 4.7%, 6.5%, and 7.7% of patients in standard, lower, and higher dose groups, respectively. Compared with standard dose groups, no significant differences in functional recovery and parenchymal hemorrhage were observed in the lower and higher dose groups.
  
  
  CONCLUSIONS
  In clinical practice, the actual dose of t-PA often differs from the recommended dose of 0.9 mg/kg, but this has no significant impact on the outcome after t-PA treatment.
authors.affiliation: Department of Neurology, St. Anne's University Hospital in Brno, Czech Republic; Masaryk University in Brno, Czech Republic, St. Anne's University Hospital in Brno, Brno, Czech Republic. Electronic address: petr.aulicky@fnusa.cz.
authors.forename: Petr
authors.initials: P
authors.lastname: Aulicky
authors.forename: Alejandro
authors.initials: A
authors.lastname: Rabinstein
authors.forename: Raymond C S
authors.initials: RC
authors.lastname: Seet
authors.forename: Jiri
authors.initials: J
authors.lastname: Neumann
authors.forename: Robert
authors.initials: R
authors.lastname: Mikulik
mesh_terms: D000328:Adult; D000368:Aged; D002545:Brain Ischemia / Q000188:drug therapy*; D004305:Dose-Response Relationship, Drug; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage* / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D020127:Recovery of Function; D012189:Retrospective Studies; D020521:Stroke / Q000188:drug therapy*; D015912:Thrombolytic Therapy / Q000379:methods*; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage* / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator