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:

Risk Score Calculators

Interactive
Excel spreadsheets

Patient Details	Value
Age, years:
Baseline NIHSS score:	≤4 5-10 11-15 ≥16
SBP, mmHg:
Pre-stroke function (mRS):	No symptoms No significant disability
Atrial fibrillation:	No Yes
Diabetes mellitus:	No Yes

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