IV tPA Effective for Stroke in Patients With Increased Body Weight

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Previous research had suggested that the benefits of IV tPA are diminished in patients weighing more than 100 kg.
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BOSTON — Results presented at the 2017 American Academy of Neurology Annual Meeting in Boston, April 22-28, confirm the efficacy of a fixed dose of 90 mg of intravenous tissue plasminogen activator (IV tPA) for ischemic stroke in patients weighing more than 100 kg.

Results from the pooled analysis conducted by Shahram Majidi, MD, and colleagues from George Washington University in Washington, DC, support current guideline recommendations from the American Stroke Association (ASA) and the American Heart Association (AHA).

Previous research suggested that the benefit of IV tPA is reduced in patients weighing >100 kg. In order to determine whether body weight >100 kg influences clinical outcomes after treatment with IV tPA, the investigators pooled data from 3 randomized clinical trials with IV tPA treatment arms: NINDS IV tPA study, Interventional Management of Stroke 3 trial (IMS-III), and Albumin Treatment of Acute Ischemic Stroke (ALIAS Parts 1 and 2). Demographic data, stroke severity, and 90-day modified Rankin Scale (mRS) score were compared between patients weighing >100 kg vs <100 kg.

The cohort included 977 patients who were treated with IV tPA; 111 (11%) had a body weight >100 kg. Median National Institutes of Health Stroke Severity scores (NIHSS) at admission did not differ between the 2 groups (12 vs 13; P= .08); however, patients weighing >100 kg had longer hospital stays compared with those weighing <100 kg (11±14 days vs 8±7 days; P =.04).

After adjusting for confounders, the investigators determined that the rate of favorable outcomes at 90 days was not significantly different in patients weighing ≤100 kg compared with those weighing >100 kg (odds ratio [OR] 0.99; 95% CI, 0.91-1.04; P =.91). Ordinal analysis also showed no significant difference in mRS scores between the 2 patient groups (OR 0.93; 95% CI, 0.64-1.37; P =.74).

The results ultimately support the fixed dose recommended by the ASA/AHA, as body weight >100 kg does not appear to affect the clinical benefit of IV tPA treatment in patients with ischemic stroke.

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Majidi S, Guerrero CL, Burger K, Qureshi A. An analysis of fixed dose IV recombinant tissue plasminogen activator (rtPA) and clinical outcomes in acute ischemic stroke patients with body weight >100 kilograms: pooled data from three randomized clinical trials. Presented at: 2017 American Academy of Neurology Annual Meeting. April 22-28, 2017; Boston, MA. Abstract 004.