Feasibility and Safety of Intravenous Thrombolysis in Multiethnic Asian Stroke Patients in Singapore

Treatment rates with intravenously administered tissue plasminogen activator (IV-tPA) in acute ischemic stroke (IS) remain low in Asian populations. Various logistic obstacles and higher anticipated bleeding risk in Asians are major concerns. We report on the feasibility and safety of IV-tPA therapy at our tertiary care center. Consecutive acute IS patients eligible for thrombolysis were treated with low-dose (maximum 50 mg) IV-tPA between January 2000 and September 2006 and with standard-dose (maximum 90 mg) IV-tPA between October 2006 and May 2008. The efficacy of IV-tPA was assessed by the modified Rankin Scale (mRS) score at 3 months and by absolute changes in the National Institute of Health Stroke Scale (NIHSS) score at hospital discharge and 3 months. The safety of IV-tPA was assessed by the rate of symptomatic intracranial hemorrhage (SICH). A total of 130 patients were included (mean age, 60 +/- 13years; 60% males; median NIHSS score, 14). A total of 48 patients received low-dose IV-tPA, and 82 patients received standard-dose IV-tPA. The median onset to treatment time was 160 minutes. Some 59% of the patients achieved functional independence (mRS score 0-1) at 3 months with standard-dose tPA, compared with 35% in the low-dose group (P = .011). SICH occurred more frequently with the low dose (14.5%) than with the standard dose (1.2%; P = .004). In a multivariate logistic regression model, lower admission NIHSS score (odds ratio [OR} = 0.78 per 1-point increase; 95% confidence interval [CI] = 0.70-0.88), lower pretreatment blood glucose level (OR = 0.76 per 1 mmol/L increase; 95% CI = 0.60-0.95), shorter time from symptom onset to IV-tPA bolus (OR = 0.97 per 1-minute increase; 95% CI = 0.94-1.0), and standard-dose IV-tPA (OR = 12.49; 95% CI = 2.9-53.89) were associated with a higher likelihood for functional independence at 3 months. Our data indicate that standard-dose IV-tPA (0.9 mg/kg) was feasible and safe for treating acute IS in our multiethnic Asian population in Singapore.