• Tsuyoshi Ohta, Kenji Okada, Maki Fukuda, Noritaka Masahira, Toshiki Matsuoka, Takaya Tsuno, and Mitsuhiro Takemura.
• Department of Neurosurgery, Kochi Health Sciences Center, Kochi City, Kochi Prefecture, Japan. Electronic address: tsuyoshi@ya2.so-net.ne.jp.
• J Stroke Cerebrovasc Dis. 2018 Jul 1; 27 (7): 1844-1851.

ObjectThe purpose of this study was to investigate the safety and efficacy of intravenous low-dose alteplase for acute ischemic stroke patients with relative contraindications.MethodsThe consecutive series of patients admitted within 4.5 hours of ischemic stroke onset between September 2012 and April 2017 were retrospectively evaluated. A good outcome at 90 days and symptomatic intracerebral hemorrhage were evaluated to determine the association with intravenous low-dose alteplase, especially in the presence of relative contraindications.ResultsIntravenous low-dose alteplase was administered to 219 of 315 patients (70%). A significantly higher number of patients treated with intravenous low-dose alteplase achieved a good outcome compared with those treated without alteplase (60% versus 44%; P = .014). The incidence of symptomatic intracerebral hemorrhage was not significantly different between the treatment groups. Multivariable logistic regression analysis of good outcome revealed that the significant independent factors were age of 81 years or older (odds ratio, .33; 95% confidence interval, .18-.60), National Institutes of Health Stroke Scale (NIHSS) of 4 or less (compared with NIHSS, 5-25; odds ratio, 3.3; 95% confidence interval, 1.8-6.4), modified Rankin scale score of 1 before stroke (odds ratio, .32; 95% confidence interval, .14-.73), and large changes on first brain imaging (odds ratio, .16; 95% confidence interval, .058-.44). Even with these relative contraindications, intravenous low-dose alteplase was still associated with good outcome (odds ratio, 3.1; 95% confidence interval, 1.6-5.8).ConclusionsIntravenous low-dose alteplase treatment can be safe and effective in relative contraindication patients with acute ischemic stroke.Copyright © 2018 National Stroke Association. Published by Elsevier Inc. All rights reserved.

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