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Tytuł pozycji:

Tissue plasminogen activator for acute ischemic stroke: calculation of dose based on estimated patient weight can increase the risk of cerebral bleeding.

Tytuł:
Tissue plasminogen activator for acute ischemic stroke: calculation of dose based on estimated patient weight can increase the risk of cerebral bleeding.
Autorzy:
García-Pastor A; Stroke Unit, Neurology Department, Hospital General Universitario Gregorio Marañón, C/Dr. Esquerdo 46, 28007, Madrid, Spain, .
Díaz-Otero F
Funes-Molina C
Benito-Conde B
Grandes-Velasco S
Sobrino-García P
Vázquez-Alén P
Fernández-Bullido Y
Villanueva-Osorio JA
Gil-Núñez A
Źródło:
Journal of thrombosis and thrombolysis [J Thromb Thrombolysis] 2015 Oct; Vol. 40 (3), pp. 347-52.
Typ publikacji:
Clinical Trial; Journal Article; Observational Study
Język:
English
Imprint Name(s):
Original Publication: [Dordrecht ; Norwell, MA] : Kluwer Academic Publishers, c1994-
MeSH Terms:
Body Weight*
Brain Ischemia/*drug therapy
Intracranial Hemorrhages/*prevention & control
Stroke/*drug therapy
Tissue Plasminogen Activator/*administration & dosage
Acute Disease ; Aged ; Aged, 80 and over ; Brain Ischemia/blood ; Female ; Humans ; Intracranial Hemorrhages/blood ; Intracranial Hemorrhages/chemically induced ; Male ; Middle Aged ; Prospective Studies ; Risk Factors ; Stroke/blood ; Tissue Plasminogen Activator/adverse effects
References:
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Substance Nomenclature:
EC 3.4.21.68 (Tissue Plasminogen Activator)
Entry Date(s):
Date Created: 20150522 Date Completed: 20160517 Latest Revision: 20220331
Update Code:
20240104
DOI:
10.1007/s11239-015-1232-4
PMID:
25995103
Czasopismo naukowe
A dose of 0.9 mg/kg of intravenous tissue plasminogen activator (t-PA) has proven to be beneficial in the treatment of acute ischemic stroke (AIS). Dosing of t-PA based on estimated patient weight (PW) increases the likelihood of errors. Our objectives were to evaluate the accuracy of estimated PW and assess the effectiveness and safety of the actual applied dose (AAD) of t-PA. We performed a prospective single-center study of AIS patients treated with t-PA from May 2010 to December 2011. Dose was calculated according to estimated PW. Patients were weighed during the 24 h following treatment with t-PA. Estimation errors and AAD were calculated. Actual PW was measured in 97 of the 108 included patients. PW estimation errors were recorded in 22.7 % and were more frequent when weight was estimated by stroke unit staff (44 %). Only 11 % of patients misreported their own weight. Mean AAD was significantly higher in patients who had intracerebral hemorrhage (ICH) after t-PA than in patients who did not (0.96 vs. 0.92 mg/kg; p = 0.02). Multivariate analysis showed an increased risk of ICH for each 10 % increase in t-PA dose above the optimal dose of 0.90 mg/kg (OR 3.10; 95 % CI 1.14-8.39; p = 0.026). No effects of t-PA misdosing were observed on symptomatic ICH, functional outcome or mortality. Estimated PW is frequently inaccurate and leads to t-PA dosing errors. Increasing doses of t-PA above 0.90 mg/kg may increase the risk of ICH. Standardized weighing methods before t-PA is administered should be considered.

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