What question did this study set out to answer?

This study aims to evaluate the efficacy and safety of low-dose alteplase compared to standard-dose alteplase in stroke patients over 80 years of age.

January 10, 2026Journal of Stroke and Cerebrovascular Diseases0 citationsOpen Access

Outcomes of Low-Dose Versus Standard-Dose Alteplase in Acute Ischemic Stroke Patients Aged Over 80 Years: A Real-World Propensity Score-Matched Study from China

CLChangsheng LiBeijing Tian Tan Hospital HGHongqiu GuCapital Medical University KYKaixuan YangCapital Medical University

Key Result

Low-dose alteplase in octogenarian stroke patients provides similar efficacy and safety to standard-dose with potentially fewer hemorrhagic complications.

Key Points

This study aims to evaluate the efficacy and safety of low-dose alteplase compared to standard-dose alteplase in stroke patients over 80 years of age.
Real-world propensity score-matched study design
Comparison of low-dose and standard-dose alteplase treatments
Analysis of outcomes related to efficacy and safety
Focus on hemorrhagic complications in octogenarian patients
Low-dose alteplase shows similar efficacy as standard-dose in treating acute ischemic stroke
Reduced hemorrhagic complications with low-dose alteplase
Support for low-dose regimens as a viable option for elderly patients.

Structured PICO

Does low-dose alteplase reduce disability or death at hospital discharge in acute ischemic stroke patients aged over 80 years compared to standard-dose alteplase?

Population

6,522 acute ischemic stroke (AIS) patients aged >80 years of Chinese ethnicity, treated with intravenous alteplase within the 4.5-hour therapeutic window following symptom onset.

Intervention

Low-dose alteplase (0.6 mg/kg, range 0.55-0.65 mg/kg) administered intravenously.

Comparator

Standard-dose alteplase (0.9 mg/kg, range 0.86-0.95 mg/kg) administered intravenously.

Outcome

Disability or death at hospital discharge, indicated by modified Rankin Scale (mRS) scores of 2-6.composite

In octogenarian acute ischemic stroke patients, low-dose alteplase offers comparable efficacy and safety to standard-dose therapy, supporting its use as a reasonable option when minimizing bleeding risk is a priority.

Main Result

Absolute Event Rate: 0% vs 0%

Abstract

In octogenarian stroke patients, low-dose alteplase offers parallel efficacy and safety to standard therapy, with a possible reduction in hemorrhagic complications. These results support low-dose regimens as a reasonable option for elderly patients, particularly when minimizing bleeding risk is a clinical priority.

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