A reduced dose of alteplase cut rates of intracerebral haemorrhage and improved patient survival, according to the results of a major clinical trial published yesterday.
The randomised controlled trial, led by Leicester University, UK, involved nearly 3,000 patients in 100 hospitals worldwide.
It compared a dose of 0.6mg/kg of rtPA with a standard dose of 0.9mg/kg.
Researchers found that 90 days after treatment some 8.5% of patients on reduced dose had died compared with 10.3% of those who received the standard dose.
But the reduced dose was also linked to a 4% increase in patients suffering residual disability, the researchers found.
The findings have been reported in the New England Journal of Medicine.
Researcher Professor Tom Robinson said: "Currently, approximately 11% of stroke patients receive thrombolysis treatment for stroke in the UK.
"The results provide important information when discussing clot-busting treatment with patients and their families.
"Most patients who have a major stroke want to know they will survive but without being seriously dependent on their family. We have shown this to be the case with the lower dose of the drug."
Fellow researcher Professor Craig Anderson said: "At the moment you could have a stroke but end up dying from a bleed in the brain. It’s largely unpredictable as to who will respond and who is at risk with rtPA.
"What we have shown is that if we reduce the dose level, we maintain most of the clot busting benefits of the higher dose but with significantly less major bleeds and improved survival rates. On a global scale, this approach could save the lives of many tens of thousands of people.
"There is a trade off with the lower dose in regards to recovery of functioning, but being alive is surely preferable to most patients than suffering an early death."
Low-Dose versus Standard-Dose Intravenous Alteplase in Acute Ischemic Stroke NEJM 10 May 2016 [abstract]
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