THAWS2
(2024)Objective
To determine the safety and efficacy of intravenous alteplase at 0.6 mg/kg for patients with acute wake-up or unclear-onset strokes in clinical practice.
Study Summary
• sICH rate: 3% (2/66); no all-cause mortality at 90 days
• Median NIHSS improved from 11 at baseline; 90-day mRS 0–2 achieved in 55% of patients
• Findings support safety of low-dose alteplase (0.6 mg/kg) for DWI-FLAIR mismatch strokes beyond 4.5 hours, though study is single-arm with no comparator
• Median NIHSS improved from 11 at baseline; 90-day mRS 0–2 achieved in 55% of patients
• Findings support safety of low-dose alteplase (0.6 mg/kg) for DWI-FLAIR mismatch strokes beyond 4.5 hours, though study is single-arm with no comparator
Intervention
Intravenous alteplase at 0.6 mg/kg for patients with last-known-well time >4.5 hours and DWI-FLAIR mismatch.
Inclusion Criteria
Acute ischemic stroke patients with last-known-well time >4.5 hours and a mismatch between DWI and FLAIR imaging.
Study Design
Arms: Single-arm observational study (no control group).
Patients per Arm: 66 patients.
Outcome
Safety outcomes included a 3% rate of symptomatic intracranial hemorrhage and 0% all-cause mortality within 90 days. Efficacy outcomes showed a median NIHSS improvement from 11 to 5 at 24 hours. At discharge, 47% had a favorable outcome and 44% had complete independence.