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| Lower t-PA dose reduces continued bleeding risk after ICH |
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17 February 2006
The risk of continued bleeding and death after tissue plasminogen activator (t-PA) treatment in intracerebral haemorrhage patients (ICH) is reduced at doses of 1mg or less, investigators claim.
During an ICH, blood often extends into the ventricles of the central brain, which increases the chances of death or severe disability. The thrombolytic drug t-PA is administered to mitigate this risk, but is associated with an increased bleeding risk. "We have good evidence that lower doses of t-PA not only worked as well as the higher dose, but also markedly reduced side effects in regard to bleeding," Dr David Hanley from Johns Hopkins University in Baltimore, Maryland, USA, told delegates at the 2006 American Stroke Association International Stroke Conference in Kissimmee, Florida. "Ten years ago, the mortality rate for this type of stroke was at 80%. One year ago, it was 50%. In this study, it was 13%."
Sixteen patients received either 0.3 or 1mg of t-PA every 6 to 12 hours through an intraventricular catheter for up to 4 days or until the brain ventricles opened. Daily CT scans showed that blood clots dissolved at similar rates for both dose sizes, and that clot removal was substantially accelerated compared with placebo-treated patients. Previously, the team had found continued bleeding in 23% of ICH patients treated with a 3 mg dose of t-PA, and a 19% fatality rate, whereas 13% of those treated with the lower doses of t-PA died, and no instances of symptomatic bleeding were observed. Analysis of cerebral spinal fluid revealed that t-PA remained at therapeutic levels for longer periods of time when administered at 1mg, rather than 0.3mg.
As the 1mg dose also appeared to clear clots more rapidly from the third and fourth ventricles, the researchers have determined to use this t-PA dose in a larger, forthcoming trial.
Reference:
American Stroke Association International Stroke Conference: Kissimmee, Florida, USA; 16-18 February 2006
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