title: Different doses of recombinant tissue-type plasminogen activator for acute stroke in Chinese patients.
abstract: OBJECTIVE
  The relationship between the dose of recombinant tissue-type plasminogen activator (r-tPA) and its safety/efficacy for ischemic stroke has not been well evaluated in the East Asian population. We assessed the safety/efficacy of different doses of r-tPA for acute ischemic stroke in Chinese patients.
  
  
  METHODS
  A total of 1004 eligible patients were classified according to the dose of r-tPA received for managing acute ischemic stroke: 0.9 mg/kg (n=422), 0.8 mg/kg (n=202), 0.7 mg/kg (n=199), and 0.6 mg/kg (n=181). The safety outcome was symptomatic intracerebral hemorrhage and death within 3 months. The efficacy outcome was good functional outcome (modified Rankin Scale ≤1) at 3 months.
  
  
  RESULTS
  There was a significant trend for symptomatic intracerebral hemorrhage with age (P=0.002). With multivariate logistic regression analysis, a dose of 0.9 mg/kg was a predictor of symptomatic intracerebral hemorrhage (P=0.0109), and a dose ≤0.65 mg/kg was a predictor of good functional outcome (P=0.0369). In patients aged 71 to 80 years, there was a significant trend of increasing symptomatic intracerebral hemorrhage (P=0.0130) and less good functional outcome (P=0.0179) with increasing doses of r-tPA. There was also a trend of increasing mortality (P=0.0971) at 3 months in these patients.
  
  
  CONCLUSIONS
  These results did not support the dose of 0.9 mg/kg of r-tPA being optimal for all patients in the East Asian population. In elderly patients (71-80 years), a lower dose of 0.6 mg/kg is associated with a better outcome. Confirmation of the results through randomized trial is required.
authors.affiliation: From the Graduate Institute of Clinical Medicine and Department of Neurology, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan (A.-C.C., C.-K.L.); Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan (A.-C.C., C.-K.L.); Department of Neurology, College of Medicine, National Cheng Kung University, Tainan, Taiwan (C.-H.C.); Department of Neurology, Chi-Mei Medical Center, Tainan, Taiwan (H.-J.L.); Department of Neurology, China Medical University Hospital, Taichung, Taiwan (C.-H.L.); Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan (J.-S.J.); Graduate Institute of Clinical Medicine and Department of Neurology, College of Medicine, Taipei Medical University, Taipei, Taiwan (C.-J.H., H.-H.H.); Department of Neurology, Taipei Veterans General Hospital and National Yang-Ming University, Taipei, Taiwan (C.-P.C., W.-Y.S.); and Department of Neurology, Tungs' Taichung Metro Harbor Hospital and Department of Neurology, School of Medicine, Chung Shan Medical University, Taichung, Taiwan (H.-Y.H.). achch@cc.kmu.edu.tw hanhwa@hotmail.com.
authors.forename: A-Ching
authors.initials: AC
authors.lastname: Chao
authors.affiliation: From the Graduate Institute of Clinical Medicine and Department of Neurology, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan (A.-C.C., C.-K.L.); Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan (A.-C.C., C.-K.L.); Department of Neurology, College of Medicine, National Cheng Kung University, Tainan, Taiwan (C.-H.C.); Department of Neurology, Chi-Mei Medical Center, Tainan, Taiwan (H.-J.L.); Department of Neurology, China Medical University Hospital, Taichung, Taiwan (C.-H.L.); Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan (J.-S.J.); Graduate Institute of Clinical Medicine and Department of Neurology, College of Medicine, Taipei Medical University, Taipei, Taiwan (C.-J.H., H.-H.H.); Department of Neurology, Taipei Veterans General Hospital and National Yang-Ming University, Taipei, Taiwan (C.-P.C., W.-Y.S.); and Department of Neurology, Tungs' Taichung Metro Harbor Hospital and Department of Neurology, School of Medicine, Chung Shan Medical University, Taichung, Taiwan (H.-Y.H.).
authors.forename: Ching-Kuan
authors.initials: CK
authors.lastname: Liu
authors.affiliation: From the Graduate Institute of Clinical Medicine and Department of Neurology, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan (A.-C.C., C.-K.L.); Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan (A.-C.C., C.-K.L.); Department of Neurology, College of Medicine, National Cheng Kung University, Tainan, Taiwan (C.-H.C.); Department of Neurology, Chi-Mei Medical Center, Tainan, Taiwan (H.-J.L.); Department of Neurology, China Medical University Hospital, Taichung, Taiwan (C.-H.L.); Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan (J.-S.J.); Graduate Institute of Clinical Medicine and Department of Neurology, College of Medicine, Taipei Medical University, Taipei, Taiwan (C.-J.H., H.-H.H.); Department of Neurology, Taipei Veterans General Hospital and National Yang-Ming University, Taipei, Taiwan (C.-P.C., W.-Y.S.); and Department of Neurology, Tungs' Taichung Metro Harbor Hospital and Department of Neurology, School of Medicine, Chung Shan Medical University, Taichung, Taiwan (H.-Y.H.).
authors.forename: Chih-Hung
authors.initials: CH
authors.lastname: Chen
authors.affiliation: From the Graduate Institute of Clinical Medicine and Department of Neurology, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan (A.-C.C., C.-K.L.); Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan (A.-C.C., C.-K.L.); Department of Neurology, College of Medicine, National Cheng Kung University, Tainan, Taiwan (C.-H.C.); Department of Neurology, Chi-Mei Medical Center, Tainan, Taiwan (H.-J.L.); Department of Neurology, China Medical University Hospital, Taichung, Taiwan (C.-H.L.); Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan (J.-S.J.); Graduate Institute of Clinical Medicine and Department of Neurology, College of Medicine, Taipei Medical University, Taipei, Taiwan (C.-J.H., H.-H.H.); Department of Neurology, Taipei Veterans General Hospital and National Yang-Ming University, Taipei, Taiwan (C.-P.C., W.-Y.S.); and Department of Neurology, Tungs' Taichung Metro Harbor Hospital and Department of Neurology, School of Medicine, Chung Shan Medical University, Taichung, Taiwan (H.-Y.H.).
authors.forename: Huey-Juan
authors.initials: HJ
authors.lastname: Lin
authors.affiliation: From the Graduate Institute of Clinical Medicine and Department of Neurology, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan (A.-C.C., C.-K.L.); Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan (A.-C.C., C.-K.L.); Department of Neurology, College of Medicine, National Cheng Kung University, Tainan, Taiwan (C.-H.C.); Department of Neurology, Chi-Mei Medical Center, Tainan, Taiwan (H.-J.L.); Department of Neurology, China Medical University Hospital, Taichung, Taiwan (C.-H.L.); Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan (J.-S.J.); Graduate Institute of Clinical Medicine and Department of Neurology, College of Medicine, Taipei Medical University, Taipei, Taiwan (C.-J.H., H.-H.H.); Department of Neurology, Taipei Veterans General Hospital and National Yang-Ming University, Taipei, Taiwan (C.-P.C., W.-Y.S.); and Department of Neurology, Tungs' Taichung Metro Harbor Hospital and Department of Neurology, School of Medicine, Chung Shan Medical University, Taichung, Taiwan (H.-Y.H.).
authors.forename: Chung-Hsiang
authors.initials: CH
authors.lastname: Liu
authors.affiliation: From the Graduate Institute of Clinical Medicine and Department of Neurology, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan (A.-C.C., C.-K.L.); Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan (A.-C.C., C.-K.L.); Department of Neurology, College of Medicine, National Cheng Kung University, Tainan, Taiwan (C.-H.C.); Department of Neurology, Chi-Mei Medical Center, Tainan, Taiwan (H.-J.L.); Department of Neurology, China Medical University Hospital, Taichung, Taiwan (C.-H.L.); Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan (J.-S.J.); Graduate Institute of Clinical Medicine and Department of Neurology, College of Medicine, Taipei Medical University, Taipei, Taiwan (C.-J.H., H.-H.H.); Department of Neurology, Taipei Veterans General Hospital and National Yang-Ming University, Taipei, Taiwan (C.-P.C., W.-Y.S.); and Department of Neurology, Tungs' Taichung Metro Harbor Hospital and Department of Neurology, School of Medicine, Chung Shan Medical University, Taichung, Taiwan (H.-Y.H.).
authors.forename: Jiann-Shing
authors.initials: JS
authors.lastname: Jeng
authors.affiliation: From the Graduate Institute of Clinical Medicine and Department of Neurology, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan (A.-C.C., C.-K.L.); Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan (A.-C.C., C.-K.L.); Department of Neurology, College of Medicine, National Cheng Kung University, Tainan, Taiwan (C.-H.C.); Department of Neurology, Chi-Mei Medical Center, Tainan, Taiwan (H.-J.L.); Department of Neurology, China Medical University Hospital, Taichung, Taiwan (C.-H.L.); Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan (J.-S.J.); Graduate Institute of Clinical Medicine and Department of Neurology, College of Medicine, Taipei Medical University, Taipei, Taiwan (C.-J.H., H.-H.H.); Department of Neurology, Taipei Veterans General Hospital and National Yang-Ming University, Taipei, Taiwan (C.-P.C., W.-Y.S.); and Department of Neurology, Tungs' Taichung Metro Harbor Hospital and Department of Neurology, School of Medicine, Chung Shan Medical University, Taichung, Taiwan (H.-Y.H.).
authors.forename: Chaur-Jong
authors.initials: CJ
authors.lastname: Hu
authors.affiliation: From the Graduate Institute of Clinical Medicine and Department of Neurology, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan (A.-C.C., C.-K.L.); Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan (A.-C.C., C.-K.L.); Department of Neurology, College of Medicine, National Cheng Kung University, Tainan, Taiwan (C.-H.C.); Department of Neurology, Chi-Mei Medical Center, Tainan, Taiwan (H.-J.L.); Department of Neurology, China Medical University Hospital, Taichung, Taiwan (C.-H.L.); Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan (J.-S.J.); Graduate Institute of Clinical Medicine and Department of Neurology, College of Medicine, Taipei Medical University, Taipei, Taiwan (C.-J.H., H.-H.H.); Department of Neurology, Taipei Veterans General Hospital and National Yang-Ming University, Taipei, Taiwan (C.-P.C., W.-Y.S.); and Department of Neurology, Tungs' Taichung Metro Harbor Hospital and Department of Neurology, School of Medicine, Chung Shan Medical University, Taichung, Taiwan (H.-Y.H.).
authors.forename: Chih-Ping
authors.initials: CP
authors.lastname: Chung
authors.affiliation: From the Graduate Institute of Clinical Medicine and Department of Neurology, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan (A.-C.C., C.-K.L.); Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan (A.-C.C., C.-K.L.); Department of Neurology, College of Medicine, National Cheng Kung University, Tainan, Taiwan (C.-H.C.); Department of Neurology, Chi-Mei Medical Center, Tainan, Taiwan (H.-J.L.); Department of Neurology, China Medical University Hospital, Taichung, Taiwan (C.-H.L.); Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan (J.-S.J.); Graduate Institute of Clinical Medicine and Department of Neurology, College of Medicine, Taipei Medical University, Taipei, Taiwan (C.-J.H., H.-H.H.); Department of Neurology, Taipei Veterans General Hospital and National Yang-Ming University, Taipei, Taiwan (C.-P.C., W.-Y.S.); and Department of Neurology, Tungs' Taichung Metro Harbor Hospital and Department of Neurology, School of Medicine, Chung Shan Medical University, Taichung, Taiwan (H.-Y.H.).
authors.forename: Hung-Yi
authors.initials: HY
authors.lastname: Hsu
authors.affiliation: From the Graduate Institute of Clinical Medicine and Department of Neurology, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan (A.-C.C., C.-K.L.); Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan (A.-C.C., C.-K.L.); Department of Neurology, College of Medicine, National Cheng Kung University, Tainan, Taiwan (C.-H.C.); Department of Neurology, Chi-Mei Medical Center, Tainan, Taiwan (H.-J.L.); Department of Neurology, China Medical University Hospital, Taichung, Taiwan (C.-H.L.); Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan (J.-S.J.); Graduate Institute of Clinical Medicine and Department of Neurology, College of Medicine, Taipei Medical University, Taipei, Taiwan (C.-J.H., H.-H.H.); Department of Neurology, Taipei Veterans General Hospital and National Yang-Ming University, Taipei, Taiwan (C.-P.C., W.-Y.S.); and Department of Neurology, Tungs' Taichung Metro Harbor Hospital and Department of Neurology, School of Medicine, Chung Shan Medical University, Taichung, Taiwan (H.-Y.H.).
authors.forename: Wen-Yung
authors.initials: WY
authors.lastname: Sheng
authors.affiliation: From the Graduate Institute of Clinical Medicine and Department of Neurology, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan (A.-C.C., C.-K.L.); Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan (A.-C.C., C.-K.L.); Department of Neurology, College of Medicine, National Cheng Kung University, Tainan, Taiwan (C.-H.C.); Department of Neurology, Chi-Mei Medical Center, Tainan, Taiwan (H.-J.L.); Department of Neurology, China Medical University Hospital, Taichung, Taiwan (C.-H.L.); Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan (J.-S.J.); Graduate Institute of Clinical Medicine and Department of Neurology, College of Medicine, Taipei Medical University, Taipei, Taiwan (C.-J.H., H.-H.H.); Department of Neurology, Taipei Veterans General Hospital and National Yang-Ming University, Taipei, Taiwan (C.-P.C., W.-Y.S.); and Department of Neurology, Tungs' Taichung Metro Harbor Hospital and Department of Neurology, School of Medicine, Chung Shan Medical University, Taichung, Taiwan (H.-Y.H.). achch@cc.kmu.edu.tw hanhwa@hotmail.com.
authors.forename: Han-Hwa
authors.initials: HH
authors.lastname: Hu
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D044466:Asian People; D002545:Brain Ischemia / Q000188:drug therapy*; D004305:Dose-Response Relationship, Drug; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D020521:Stroke / Q000188:drug therapy*; D015912:Thrombolytic Therapy / Q000009:adverse effects / Q000379:methods*; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator
keywords: cerebral hemorrhage; stroke