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Intravenous thrombolysis with low-dose recombinant tissue plasminogen activator in acute ischemic stroke.

To the Editor:

We read with interest the study by Toyoda et al1 regarding intravenous thrombolysis with low-dose tissue plasminogen activator (IV tPA) in Japanese patients with acute ischemic stroke (IS). We want to discuss some important issues raised by this study.

Data regarding thrombolysis in Asia are scarce. Only a small proportion of patients with acute IS are thrombolyzed in Asia and the treatment approach remains largely conservative.2 Patients’ late arrival, treatment costs, and limited access to neuroimaging are some of the major contributing factors.

A major concern has been the anticipated higher rates of tPA-related symptomatic intracranial …