Safety of Standard-dose (.9-mg/kg) Alteplase Intravenous Thrombolysis for Acute Ischemic Stroke in Afro–Caribbeans, French West Indies

• Published in: Journal of stroke and cerebrovascular diseases Vol. 23; no. 7; pp. 1776 - 1780
• Main Authors: Chausson, Nicolas, MD, Olindo, Stéphane, MD, Joux, Julien, MD, Saint-Vil, Martine, MD, Aveillan, Mathieu, MD, Smadja, Didier, MD, PhD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.08.2014
• Subjects: African Americans; Aged; Aging - physiology; alteplase; Blacks; Brain Ischemia - drug therapy; Cardiovascular; Caribbean; Cohort Studies; Female; Fibrinolytic Agents - administration & dosage; Fibrinolytic Agents - adverse effects; Fibrinolytic Agents - therapeutic use; fibrinolytic therapy; Humans; Intracranial Hemorrhages - chemically induced; Male; Middle Aged; Nervous System Diseases - etiology; Neurology; stroke; Stroke - drug therapy; Thrombolytic Therapy - methods; Tissue Plasminogen Activator - administration & dosage; Tissue Plasminogen Activator - adverse effects; Tissue Plasminogen Activator - therapeutic use; West Indies; West Indies; fibrinolytic therapy; Blacks; Caribbean; stroke; alteplase
• ISSN: 1052-3057; 1532-8511
• DOI: 10.1016/j.jstrokecerebrovasdis.2014.05.004

Background Pharmacobiologic data suggested that people of African ancestry were more sensitive to the recombinant tissue plasminogen activator, alteplase, than Caucasians. Furthermore, the higher incidences of hypertension and diabetes mellitus in black populations could contribute to a higher cerebral bleeding risk. However, standard-dose (.9-mg/kg) alteplase safety for stroke has never been evaluated in blacks. This study was undertaken to evaluate standard-dose alteplase safety to treat strokes in an Afro–Caribbean population. Methods Parenchymal hemorrhage and symptomatic intracerebral hemorrhage rates in Afro–Caribbean Martinicans given standard-dose alteplase for acute stroke were evaluated based on prospectively collected data from 2007 to 2010 and compared with those from studies on predominantly Caucasian stroke victims. Results Parenchymal hemorrhage type 2 and symptomatic intracerebral hemorrhages, as defined by the third European Cooperative Acute Stroke Study, respectively, occurred in 15 (10.1%) and 12 (8.1%) of the 148 thrombolyzed Afro–Caribbeans, respectively. This excess bleeding risk (parenchymal hemorrhage type 2) concerned more patients >70 than those 70 years of age or lesser (respectively, 17.6% [13 of 74] vs. 2.7% [2 of 74]). Older age was the only factor significantly associated with a higher parenchymal hemorrhage type 2 risk ( P  = .02). Conclusions The excess hemorrhagic risk after standard-dose alteplase infusion into older Afro–Caribbean patients warrants further study to determine the possible role of cerebral microangiopathy and should be evaluated in different black populations.