Is 90 mg TPA Enough in Overweight Patients?

Mark J. Alberts, MD


July 07, 2011

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Hello, and welcome to this Medscape stroke update. My name is Dr. Mark Alberts, Professor of Neurology at Northwestern University in Chicago, and Director of the Stroke Program at Northwestern Memorial Hospital. Today I would like to talk about a new study published in the June 2011 edition of Stroke.[1] This study was done by Diedler and colleagues at several different medical centers and hospitals in Europe. They asked the question of whether the 90-mg dosing limit of tissue plasminogen activator (TPA) is appropriate for patients who are heavier (weighing more than 100 kg).

They looked at data from the SITS [Safe Implementation of Treatments in Stroke] registry, where they had information on more than 27,000 patients treated with intravenous TPA, 4% of whom weighed more than 100 kg. They looked at baseline characteristics, and clinical outcomes. What they found was very interesting. Even though these patients did not receive more TPA because of their higher weight (they were all capped at the 90-mg total dosing limit); overall, the outcomes in terms of functional improvement were essentially the same whether the patients weighed less than or more than 100 kg.

What was very interesting however is that the heavier patients, even though their total dosing was less, tended to have a higher rate of intracerebral hemorrhage. It is not clear why this was the case. The investigators did adjust the results for all reasonable medical comorbidities, but even doing that, the heavier patients (those weighing more than 100 kg) tended to have a higher rate of intracerebral hemorrhage. These results tell me is that what we are currently doing, in terms of capping the dose of TPA at 90 mg, even for heavier patients, is not only the right thing to do, in terms of efficacy, but also seems to be the right thing to do, in terms of not causing more cerebral hemorrhages. Thank you very much for joining me for this Medscape stroke update.


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