Individualized tool in ENCHANTED

An individualized decision making tool for use of low versus standard dose alteplase in acute ischemic stroke

Population of interest: thrombolysis eligible patients with acute ischemic stroke

Outcome:

      Benefit: scores 0-1 on the modified Rankin Scale at 90-days;

      Risk: symptomatic intracerebral hemorrhage defined by SITS-MOST

Predictors:

  • Age
  • Baseline NIHSS score
  • SBP
  • Pre-stroke mRS
  • Atrial Fibrillation
  • Diabetes mellitus

Risk Score Calculators

Interactive
Excel spreadsheets

Table 1 Final predictive model for benefit* at 90 days

Estimate SE P value
mRS modified Rankin scale, NIHSS National Institutes of Health Stroke Scale, BP blood pressure
*according to scores 0-1 on the mRS at 90-days
Age -0.0117 0.00355 0.001
Systolic BP -0.00598 0.00204 0.003
NIHSS ≤4 Ref
NIHSS 5-10 -0.9667 0.1102 <.0001
NIHSS 11-15 -1.9048 0.1299 <.0001
NIHSS ≥16 -2.4569 0.1431 <.0001
Pre-stroke function (mRS 1 vs. 0) -0.7921 0.1089 <.0001
Atrial fibrillation (Yes vs. No) 1.3955 0.6471 0.031
Diabetes mellitus (Yes vs. No) -0.2604 0.0996 0.009
Randomised treatment (low vs. standard-dose alteplase) -0.1443 0.0788 0.067
Age * atrial fibrillation -0.0238 0.00905 0.009

 

Table 2 Final predictive model for the risk of symptomatic intracranial hemorrhage*

Estimate SE P value
BP blood pressure
*defined according to the Safe Implementation of Thrombolysis in Stroke-Monitoring Study (SITS-MOST)
Systolic BP 0.0206 0.00783 0.009
Atrial fibrillation (Yes vs. No) 1.3316 0.2873 <0.0001
Randomised treatment (low vs. standard-dose alteplase) -0.8018 0.3054 0.009