Most Read Articles
Pank Jit Sin, 07 Jan 2015

Cardiovascular diseases (CVD) have been the main cause of death in the Malaysian population since 2007. This trend has continued, with the number of people dying from CVD-related causes increasing year on year. 

Elaine Soliven, 11 Oct 2017
Reducing daily salt intake is associated with improved blood pressure (BP) levels in patients with hypertension, according to a study presented at APCH 2017.
Roshini Claire Anthony, 28 Sep 2017

Intensive blood pressure (BP) lowering appears to reduce mortality risk during treatment in individuals with hypertension and moderate-to-advanced chronic kidney disease (CKD), findings from a recent systematic review and meta-analysis show.

21 Sep 2017
The risk of coronary heart disease (CHD), cerebrovascular disease and heart failure is greater among metabolically healthy obese than normal weight metabolically healthy individuals, suggests a recent study. Additionally, even those who are normal weight can have metabolic abnormalities and similar risks for cardiovascular disease (CVD) events.

Favourable clinical outcomes, lower sICH with low-dose alteplase in patients with prior antiplatelet therapy

Audrey Abella
17 Aug 2017

The use of low-dose intravenous (IV) alteplase may be associated with more favourable clinical outcomes and lower risk of symptomatic intracerebral haemorrhage (sICH) in thrombolysis-treated acute ischaemic stroke patients who previously received antiplatelet therapy (APT) compared with the standard dose, according to the ENCHANTED* trial.

This multicentre, prospective, blinded-end point trial included 3,285 patients (mean age 66.6 years, 38 percent women). The 752 patients who reported prior APT use were randomized to receive low-dose (0.6 mg/kg, n=407) or standard-dose (0.9 mg/kg, n=345) IV alteplase within 4.5 hours of symptom onset.

Although not significant, low-dose alteplase resulted in a more favourable 90-day clinical outcome than standard-dose alteplase in patients with APT history vs those without prior APT based on mRS (modified Rankin Scale) scores 2–6 (odds ratio [OR], 0.84 vs OR, 1.16; p-trend=0.053), mRS scores 3–6 (OR, 0.80 vs OR, 1.10; p-trend=0.065), or ordinal mRS shift (OR, 0.76 vs OR, 1.07; p interaction=0.023). [Stroke 2017;48:1877-1883]

Based on the SITS-MOST** criteria, prior APT use was associated with an increased sICH risk (adjusted OR, 1.82, 95 percent CI, 1.00–3.30; p=0.051), which decreased in patients given low-dose vs standard-dose alteplase (OR, 0.38, 95 percent CI, 0.14–1.02).

“Patients on prior APT … are at significantly higher risk of sICH and poor outcome compared with other patients who receive alteplase,” said the researchers. “[T]his may be considered an important treatment option in such patients.”

The researchers highlighted that while the numbers are ‘too small’ to offer a reliable risk assessment based on varying doses of alteplase, some study protocols have recommended the avoidance of APT for at least 24 hours after alteplase use. [Stroke 2013;44:870-947; Cochrane Database Syst Rev 2014;7:CD000213]

Overall, although nonsignificant, the results suggest a trend towards better clinical outcomes with low-dose vs standard-dose alteplase, said the researchers, who called for randomized trials to elucidate the effects of low-dose and standard-dose alteplase in patients with APT history.

The potential benefits of low-dose alteplase in patients with high sICH risk should also be further investigated, they added.

 

Digital Edition
Asia's trusted medical magazine for healthcare professionals. Get your MIMS Cardiology - Malaysia digital copy today!
DOWNLOAD
Editor's Recommendations
Most Read Articles
Pank Jit Sin, 07 Jan 2015

Cardiovascular diseases (CVD) have been the main cause of death in the Malaysian population since 2007. This trend has continued, with the number of people dying from CVD-related causes increasing year on year. 

Elaine Soliven, 11 Oct 2017
Reducing daily salt intake is associated with improved blood pressure (BP) levels in patients with hypertension, according to a study presented at APCH 2017.
Roshini Claire Anthony, 28 Sep 2017

Intensive blood pressure (BP) lowering appears to reduce mortality risk during treatment in individuals with hypertension and moderate-to-advanced chronic kidney disease (CKD), findings from a recent systematic review and meta-analysis show.

21 Sep 2017
The risk of coronary heart disease (CHD), cerebrovascular disease and heart failure is greater among metabolically healthy obese than normal weight metabolically healthy individuals, suggests a recent study. Additionally, even those who are normal weight can have metabolic abnormalities and similar risks for cardiovascular disease (CVD) events.