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Who may benefit from lower dosages of intravenous tissue plasminogen activator? Results from a cluster data analysis

Yi Dong, Ye Han, Haipeng Shen, Yilong Wang, Frank Ma, Hao Li, Yongjun Wang, Qiang Dong
DOI: 10.1136/svn-2020-000388 Published 29 December 2020
Yi Dong
1 Department of Neurology, Huashan Hospital Fudan University, Shanghai, Shanghai, China
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Ye Han
2 Department of Business Administration, College of Business, University of Illinois at Urbana-Champaign, Champaign, Illinois, USA
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Haipeng Shen
3 Faculty of Business and Economics, University of Hong Kong, Hong Kong, China
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Yilong Wang
4 Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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Frank Ma
5 Medical Research Center, DotHealth, Shanghai, China
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Hao Li
6 Big data and AI dempartment, China National Clinical Research Center for Neurological Diseases, Beijing, China
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Yongjun Wang
4 Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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Qiang Dong
1 Department of Neurology, Huashan Hospital Fudan University, Shanghai, Shanghai, China
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    Figure 1

    Interaction tree generated by supervised cluster analysis. This picture illustrates the process of interaction tree model. Group C was first split out, which showed the heterogeneity between group C and the rest in aspects of tPA effects on sICH. Then group A and group B were separated. NIHSS, National Institutes of Health Stroke Scale; sICH, symptomatic intracranial haemorrhage; tPA, tissue plasminogen activator.

Tables

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  • Table 1

    Rare event logistic regression of interventional effect on efficacy and safety among groups

    n (%)n1 (%)n2 (%)OR95% CIP value
    Interventional effect on clinical improvement
     Mild stroke283 (32.7)65 (63.1)496 (66.9)0.810.51 to 1.280.3554
     Moderate stroke704 (39.5)122 (58.1)899 (59.3)1.230.71 to 2.130.4551
     Severe stroke245 (30.4)59 (64.8)416 (66.1)1.120.58 to 2.170.7278
    Interventional effect on sICH
     Mild stroke17 (1.97)4 (3.77)13 (1.71)2.710.80 to 7.690.1026
     Moderate stroke59 (3.31)2 (0.94)57 (3.63)0.130.02 to 0.680.0159*
     Severe stroke71 (8.80)14 (13.3)57 (8.12)0.650.19 to 2.550.5180
    • Groups: mild: NIHSS 0–4; moderate: NIHSS 5–14; severe: NIHSS ≥15.

    • *P<0.05. Compared with those treated with standard dosage, patients treated with lower dosage of tPA have significantly less risk of sICH.

    • n1, number in low dose group; n2, number in standard dose group; n, total sample size in each group; NIHSS, National Institutes of Health Stroke Scale; sICH, symptomatic intracranial haemorrhage; tPA, tissue plasminogen activator.

  • Table 2

    Comparison of demographics and outcome among three subgroups

    Mild stroke
    n=865
    Moderate stroke
    n=1784
    Severe stroke
    n=807
    P value
    Number of lower dosage (%)106 (12.25)212 (11.88)105 (13.01)0.719
    Age (years), n<0.001
     <45399517
     45–64464803269
     ≥65357872515
    Sex: male, n (%)583 (67.40)1193 (66.87)463 (57.37)<0.0001
    Median onset to needle, hours2.9332.8332.667<0.0001
    History and risk factors, n (%)
     Hypertension526 (60.81)1051 (58.91)503 (62.33)0.235
     Diabetes185 (21.39)378 (21.19)156 (19.33)0.496
     Stroke82 (9.48)220 (12.33)132 (16.36)0.0001
     TIA17 (1.97)71 (3.98)37 (4.58)0.008
     Atrial fibrillation59 (6.82)266 (14.91)273 (33.83)<0.0001
    Outcome, n (%) 
     sICH17 (1.97)59 (3.31)71 (8.80)<0.0001
     Clinical improvement582 (67.3)1080 (60.5)475 (58.9)0.0001
    • Groups: mild: NIHSS 0–4; moderate: NIHSS 5–14; severe: NIHSS ≥15.

    • NIHSS, National Institutes of Health Stroke Scale; sICH, symptomatic intracranial haemorrhage; TIA, transient ischaemic attack.

Supplementary Materials

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    [svn-2020-000388supp001.pdf]

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Who may benefit from lower dosages of intravenous tissue plasminogen activator? Results from a cluster data analysis
Yi Dong, Ye Han, Haipeng Shen, Yilong Wang, Frank Ma, Hao Li, Yongjun Wang, Qiang Dong
Stroke and Vascular Neurology Dec 2020, 5 (4) 348-352; DOI: 10.1136/svn-2020-000388

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Who may benefit from lower dosages of intravenous tissue plasminogen activator? Results from a cluster data analysis
Yi Dong, Ye Han, Haipeng Shen, Yilong Wang, Frank Ma, Hao Li, Yongjun Wang, Qiang Dong
Stroke and Vascular Neurology Dec 2020, 5 (4) 348-352; DOI: 10.1136/svn-2020-000388
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Who may benefit from lower dosages of intravenous tissue plasminogen activator? Results from a cluster data analysis
Yi Dong, Ye Han, Haipeng Shen, Yilong Wang, Frank Ma, Hao Li, Yongjun Wang, Qiang Dong
Stroke and Vascular Neurology Dec 2020, 5 (4) 348-352; DOI: 10.1136/svn-2020-000388
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