Update on thrombolysis beyond 4.5 hours registry in Indonesia: Efficacy and safety of low dose alteplase within 4.5 to 6 hours of onset

Background: Standard treatment for acute ischemic stroke revascularization is intravenous thrombolysis using alteplase 0.9 mg/kg BW given within 4.5 hours of onset. There was no convincing evidence on the efficacy and safety of thrombolysis beyond 4.5 hours. Beside using 0.9 mg/kg BW dose, several studies have shown low dose alteplase were also effective and safe.
Objective: We intend to update our report our on the efficacy and safety of low dose alteplase in acute ischemic stroke given beyond 4.5 hours
Patients and Methods/Material and Methods: A retrospective study using data from thrombolysis registry, focusing on acute ischemic stroke patients who received 0.6 mg/kg BW alteplase within 4.5 to 6 hours of onset, in Cipto Mangunkusumo National Hospital, Jakarta. Data from January 2015 to December 2016 were obtained. The data were descriptively analyzed to get information about efficacy (outcome after 24 hours of thrombolysis and at discharged time as measured by NIHSS) and also safety (hemorrhagic complication).
Results: There were 22 patient, 12 females and 10 males, with mean age 56.5 ± 12 years. Mean symptom onset to treatment was 327.8 minutes (5 hours 27 minutes). Mean NIHSS on admission was 10 ± 5.4, while after 24 hours of thrombolysis was 6 ± 2.5 and 3 ± 2.30 on discharged time. No hemorrhagic complication occurred.
Conclusion: Intravenous alteplase with 0.6 mg/kg BW dose given within 4.5 to 6 hours was effective and safe. However, we still wait until larger number of subjects obtained and assessment of functional outcome at least after 90 days of onset acquired, to make definite conclusion.