RT Journal Article
SR Electronic
T1 Thrombolysis with alteplase 3–4.5 hours after acute ischaemic stroke: the first multicentre, phase III trial in China
JF Stroke and Vascular Neurology
JO Stroke Vasc Neurol
FD BMJ Publishing Group Ltd
SP svn-2020-000337
DO 10.1136/svn-2020-000337
A1 Zheng, Huaguang
A1 Yang, Yi
A1 Chen, Huisheng
A1 Li, Chuanling
A1 Chen, Yangkun
A1 Shi, Fu-Dong
A1 Yang, Li
A1 Cui, Xiaoping
A1 Lu, Zuneng
A1 Liang, Yanling
A1 Cui, Songbiao
A1 Xu, Anding
A1 Wu, Yiqing
A1 Sun, Yaqing
A1 Wang, Yongjun
YR 2020
UL http://svn.bmj.com/content/early/2020/05/28/svn-2020-000337.abstract
AB Background and purpose Data on the efficacy and safety of alteplase for acute ischaemic stroke (AIS) administered 3–4.5 hours after the onset of stroke symptoms in Chinese patients is limited. We sought to determine whether AIS patients would benefit from thrombolysis with alteplase between 3 and 4.5 hours after the onset of stroke symptoms in a prospective, multicentre, single-arm trial in China.Materials and methods Eligible AIS patients were given 0.9 mg/kg alteplase intravenously. The primary efficacy endpoint was a favourable outcome at 3 months, defined as a score of 0 or 1 on the modified Rankin Scale. Thresholds for the primary efficacy endpoint were determined to be 40% based on the literature review. The primary safety endpoint was symptomatic intracranial haemorrhage (sICH) according to the European Cooperative Acute Stroke Study III (ECASS III) trial definition. Post hoc analysis between this study and the ECASS III trial were compared using the propensity score matching (PSM) method.Results A total of 120 eligible AIS patients from 11 sites in China received thrombolysis therapy in this study. The median time from onset of symptoms to needle was 3 hours 54 min. The percentage of patients with a favourable outcome was 63.3% (95% CI 54.4 to 71.4), significantly higher than the predefined threshold (p<0.0001). Three patients (2.5%, 95% CI 0.5 to 7.1) had sICH, including two fatal sICH. Six patients died within 3 months after treatment. The post hoc PSM analysis showed a numerically higher rate of the primary efficacy endpoint in this study (63.3%) than the matched placebo arm (56.7%) in the ECASS III trial.Conclusions Intravenous alteplase with a standard dose administered between 3 and 4.5 hours after onset of symptoms is effective and safe for Chinese AIS patients.Trial registration number NCT02930837