Impact of different doses of intravenous alteplase on neuroinjury biomarker levels in patients with acute ischemic stroke and stress hyperglycemia.

Abstract

Intravenous alteplase thrombolysis is a primary treatment for acute ischemic stroke (AIS), but the optimal dose remains uncertain in patients with stress hyperglycemia. This study aims to compare the changes in neuroinjury biomarker levels, as well as the efficacy and safety, between low-dose (0.6 mg/kg) and standard-dose (0.9 mg/kg) intravenous alteplase treatment in patients with AIS and stress hyperglycemia. This study included 150 patients with AIS and stress hyperglycemia, who were divided into a low-dose group (n = 78) and a standard-dose group (n = 72). Differences between the 2 groups were analyzed in terms of neuroinjury biomarkers (neuro-specific enolase, S100β, glial fibrillary acidic protein, myelin basic protein), neurological recovery (National Institutes of Health Stroke Scale score), clinical outcomes (modified Rankin Scale score), and the incidence of adverse events. Multivariate regression analysis was conducted to evaluate the relationship between the dose and a favorable prognosis (modified Rankin Scale ≤ 2). We found that, within 24 hours post-treatment, the levels of neuroinjury biomarkers (neuro-specific enolase, S100β, glial fibrillary acidic protein, myelin basic protein) were significantly lower in the low-dose group compared with the standard-dose group (P < .05), and the improvement in National Institutes of Health Stroke Scale scores was more pronounced (P < .01). Three months after thrombolysis, the favorable prognosis rate in the low-dose group was 63.5%, higher than the 47.2% in the standard-dose group, with a near-significant difference (P = .09). Multivariate regression analysis indicated that low-dose treatment was an independent protective factor for a favorable prognosis (odds ratio = 2.34, 95% confidence interval = 1.29-4.23, P = .006). There were no significant differences in the incidence of adverse events between the 2 groups, though the proportion of mild bleeding was slightly lower in the low-dose group compared with the standard-dose group. Low-dose intravenous alteplase thrombolysis demonstrates more significant neuroprotective effects in patients with AIS and stress hyperglycemia, promoting neurological recovery and improving long-term prognosis without increasing the risk of adverse events. Low-dose thrombolysis may be a safer and more effective treatment option, but its efficacy and safety require further validation through large-scale, randomized controlled trials.