Stroke units in the Philippines: An observational study.

BACKGROUND: In high-income countries, the management of stroke has changed substantially over the years with the advent of thrombolysis and endovascular treatment. However, in low-income countries, such interventions may not be available, or patients may come to the hospital outside the time window no longer qualified for this therapy. Most studies on stroke units were conducted in high-income countries. Unfortunately, there has been no local multicenter data with large patient numbers showing the effectiveness of stroke units in the Southeast Asian region. AIM: To compare the outcomes of patients allocated to stroke units (based on accepted criteria) to those allocated to general neurology wards in the Philippines. METHODS: This is an open, prospective, parallel, observational comparative study of patients from 11 institutions in the Philippines. Patients were allocated either to the stroke unit or to the general neurology ward by the admitting physician based on the criteria suggested by the Stroke Trialist Collaboration Group. The primary outcome was to determine in-hospital mortality at three- and six months in both stroke units and general neurology wards. The secondary outcomes were determined by a dichotomized modified Rankin scale: (0-2) independent and (3-5) dependent. RESULTS: A total of 1025 patients were included in the study. In the primary outcome, a higher mortality rate (8.4% vs 1.0%) in the general neurology ward (p = 0.000) was seen. The six-month mortality rate was statistically significant and higher among patients admitted to the general neurology ward (3.1% vs 0.8%) (p = 0.009). Patients admitted to the stroke unit attained an independent functional outcome (mRS 0-2) as compared to the general neurology ward (73% vs 61.5%) (p = 0.000). Analysis of functionality at six months favored patients admitted in the stroke unit (88.5% vs 81.4%) as compared to the general neurology ward. CONCLUSION: Patients specifically admitted to stroke units in the Philippines based on established criteria have better outcomes than those admitted to general neurology wards.

Low-dose versus standard-dose alteplase in acute ischemic stroke in Asian stroke registries: an individual patient data pooling study.

OBJECTIVE: To investigate the comparative efficacy and safety of the low-dose versus standard-dose alteplase using real-world acute stroke registry data from Asian countries. METHODS: Individual participant data were obtained from nine acute stroke registries from China, Japan, Philippines, Singapore, South Korea, and Taiwan between 2005 and 2018. Inverse probability of treatment weight was used to remove baseline imbalances between those receiving low-dose versus standard-dose alteplase. The primary outcome was death or disability defined by modified Rankin Scale scores of 2 to 6 at 90 days. Secondary outcomes were symptomatic intracerebral hemorrhage and death. Generalized linear mixed models with the individual registry as a random intercept were performed to determine associations of treatment with low-dose alteplase and outcomes. RESULTS: Of the 6250 patients (mean age 66 years, 36% women) included in these analyses, 1610 (24%) were treated with low-dose intravenous alteplase. Clinical outcomes for low-dose alteplase were not significantly different to those for standard-dose alteplase, adjusted odds ratios for death or disability: 1.00 (0.85-1.19) and symptomatic intracerebral hemorrhage 0.87 (0.63-1.19), except for lower death with borderline significance, 0.77 (0.59-1.01). CONCLUSIONS: The present analyses of real-world Asian acute stroke registry data suggest that low-dose intravenous alteplase has overall comparable efficacy for functional recovery and greater potential safety in terms of reduced mortality, to standard-dose alteplase for the treatment of acute ischemic stroke.