title: Safety of standard-dose (.9-mg/kg) alteplase intravenous thrombolysis for acute ischemic stroke in Afro-Caribbeans, French West Indies.
abstract: BACKGROUND
  Pharmacobiologic data suggested that people of African ancestry were more sensitive to the recombinant tissue plasminogen activator, alteplase, than Caucasians. Furthermore, the higher incidences of hypertension and diabetes mellitus in black populations could contribute to a higher cerebral bleeding risk. However, standard-dose (.9-mg/kg) alteplase safety for stroke has never been evaluated in blacks. This study was undertaken to evaluate standard-dose alteplase safety to treat strokes in an Afro-Caribbean population.
  
  
  METHODS
  Parenchymal hemorrhage and symptomatic intracerebral hemorrhage rates in Afro-Caribbean Martinicans given standard-dose alteplase for acute stroke were evaluated based on prospectively collected data from 2007 to 2010 and compared with those from studies on predominantly Caucasian stroke victims.
  
  
  RESULTS
  Parenchymal hemorrhage type 2 and symptomatic intracerebral hemorrhages, as defined by the third European Cooperative Acute Stroke Study, respectively, occurred in 15 (10.1%) and 12 (8.1%) of the 148 thrombolyzed Afro-Caribbeans, respectively. This excess bleeding risk (parenchymal hemorrhage type 2) concerned more patients >70 than those 70 years of age or lesser (respectively, 17.6% [13 of 74] vs. 2.7% [2 of 74]). Older age was the only factor significantly associated with a higher parenchymal hemorrhage type 2 risk (P = .02).
  
  
  CONCLUSIONS
  The excess hemorrhagic risk after standard-dose alteplase infusion into older Afro-Caribbean patients warrants further study to determine the possible role of cerebral microangiopathy and should be evaluated in different black populations.
authors: Department of Neurology, University Hospital Fort-de-France, Fort-de-France, Martinique, France. Electronic address: nicolaschausson@hotmail.com.
authors: Nicolas
authors: N
authors: Chausson
authors: Department of Neurology, University Hospital Fort-de-France, Fort-de-France, Martinique, France.
authors: Stéphane
authors: S
authors: Olindo
authors: Department of Neurology, University Hospital Fort-de-France, Fort-de-France, Martinique, France.
authors: Julien
authors: J
authors: Joux
authors: Department of Neurology, University Hospital Fort-de-France, Fort-de-France, Martinique, France.
authors: Martine
authors: M
authors: Saint-Vil
authors: Department of Neuroradiology, University Hospital Fort-de-France, Fort-de-France, Martinique, France.
authors: Mathieu
authors: M
authors: Aveillan
authors: Department of Neurology, University Hospital Fort-de-France, Fort-de-France, Martinique, France.
authors: Didier
authors: D
authors: Smadja
mesh_terms: D001741:Black or African American; D000368:Aged; D000375:Aging / Q000502:physiology; D002545:Brain Ischemia / Q000188:drug therapy*; D015331:Cohort Studies; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D020300:Intracranial Hemorrhages / Q000139:chemically induced; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000209:etiology; D020521:Stroke / Q000188:drug therapy*; D015912:Thrombolytic Therapy / Q000379:methods*; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use*; D014900:West Indies
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator
keywords: Blacks; Caribbean; alteplase; fibrinolytic therapy; stroke