Optimal Stroke Thrombolysis in Asian Population - Insights from SITS-NEW Study

초록

Optimal Stroke Thrombolysis in Asian Population Since the NINDS rtPA study, thrombolytic therapy has been the only approved treatment for the acute ischemic stroke for almost 20 years. But many issues of clinical practice are still unresolved yet. First of all, the proportion of subjects under intravenous (IV) thrombolysis remains still quite low. The main reason is supposed to be too many contraindications for IV tPA, though each one of which lacks scientific background. Now there is growing consensus that some contraindications could be regarded as relative, and the risk and benefit of IV tPA in a given patient should be considered individually. Age, particularly over 80, is another subject of debate for the IV tPA indication. Also, the definition of minor symptom, which usually excludes the IV tPA use, has no universal criteria and have to be determined more comprehensively and precisely. Because most pivotal trial for the thrombolysis in acute ischemic stroke has been run in Western countries, some concerns about the ethnic difference in response to thrombolytic therapy has been raised, and reduced dose (0.6mg/kg) IV tPA is used in some Asian countries and particularly in Japan. But according to a recently published IV tPA registry study in Asian countries (SITS-NEW) which used standard dose (0.9mg/kg) IV tPA, even though counteracted by slight tendency of more hemorrhagic risk, the overall efficacy was better in adjusted comparison with similar study in Europe (SITS-MOST). A clinical trial (ENCHANTED), which compares the two doses regimen, is recently initiated and the result can answer whether reduced dose would show better safety without loss of efficacy.