Low-dose versus standard-dose intravenous alteplase for octogenerian acute ischemic stroke patients: A multicenter prospective cohort study

The optimal dose of alteplase for acute ischemic stroke among geriatric patients is unclear. We aimed to assess the efficacy and safety of a low-dose (0.6 mg/kg) and standard-dose (0.9 mg/kg) alteplase for varying severity of Asian geriatric stroke patients. The favorable functional outcome on day 90 after stroke onset, and the symptomatic intracranial hemorrhage (SICH) rate following 24–36 h of intravenous alteplase were measured. The baseline NIHSS of 4–8, 9–13, ≥14 were defined as mild, moderate, and high severity, respectively. Totally, 249 geriatric patients treated with low-dose (n = 108) and standard-dose (n = 141) alteplase. Compared to standard-dose alteplase, low-dose alteplase had decrease in favorable functional outcome (22.2% versus 34.8%), and no difference in SICH rates was observed. For mild severity patients, the mortality was significantly increased with standard-dose alteplase (the NNT/NNH = 22.9/8.0 for mild severity, the NNT/ NNH = 15.0/14.7 for moderate severity, and the NNT/NNH = 13.5/19.6 for high severity). Standard-dose and low-dose alteplase were comparable in reducing major disability, but low-dose alteplase for mild stroke showed much reduced mortality on day 90 for octogenarians. •Totally, 249 geriatric stroke patients treated with low-dose of 0.6 mg/kg (n=108) and standard-dose (n=141) alteplase.•The stroke severity was defined by NIHSS of 4–8, 9–13, and ≥14 as mild (n=53), moderate (n=64), and high severity (n=128).•For mild severity, the low-dose group had much reduced mortality. The NNT (mRS 0–2) and NNH (mRS 6) were 22.9 and 8.0.•For moderate and high severity patients, the efficacy and safety between the low- and standard-dose groups were comparable.•The NNT/NNH was 15.0/14.7 for moderate severity, and was 13.5/ 19.6 for high severity.