Background
Despite stroke's high prevalence in the elderly, intravenous thrombolysis is licensed
in Europe only for patients younger than 80 years old. We aimed to compare the functional
outcomes and complication rates in patients older versus younger than 80 years old
treated with intravenous thrombolysis.
Methods
A retrospective observational study of patients who received intravenous thrombolysis
in a stroke unit between January 1, 2009, and June 30, 2012, was conducted. Variables
were compared between 2 subgroups (≤80 and >80 years).
Results
Overall, 512 patients underwent intravenous thrombolysis, of which 13.1% were over
80 years. The mean age was 65.4 years in the younger subgroup and 82.9 years in the
older subgroup. Prior independence rates did not differ between the subgroups. Prevalence
of atrial fibrillation and cardioembolic stroke was higher in the older subgroup (P = .004 and .026). Only 3% of the elderly with atrial fibrillation were taking oral
anticoagulants. Symptoms-to-needle time was lower in the older subgroup (P = .048). Stroke severity was higher in patients over 80 years (P = .026). There was significant improvement in the National Institutes of Health Stroke
Scale score 7 days after intravenous thrombolysis (P < .001) in both subgroups. The proportion of patients with 3 months' favorable outcome
and independence, hemorrhagic transformation, and mortality rates were similar in
both subgroups.
Conclusions
Elderly patients' benefits and outcomes from intravenous thrombolysis treatment were
identical to the younger subgroup without excess hemorrhagic transformation or mortality.
These results favor the use of intravenous thrombolysis in patients over 80 years.
Key Words
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Stroke and Cerebrovascular DiseasesAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Global Burden of Diseases, Injuries, and Risk Factors Study 2010 (GBD 2010) and the GBD Stroke Experts Group: global and regional burden of stroke during 1990-2010: findings from the Global Burden of Disease Study 2010.Lancet. 2014; 383: 245-254
- Primary prevention of ischemic stroke: a guideline from the American Heart Association/American Stroke Association Stroke Council: cosponsored by the Atherosclerotic Peripheral Vascular Disease Interdisciplinary Working Group; Cardiovascular Nursing Council; Clinical Cardiology Council; Nutrition, Physical Activity, and Metabolism Council; and the Quality of Care and Outcomes Research Interdisciplinary Working Group.Stroke. 2006; 37: 1583-1633
- Ischemic stroke in the elderly: an overview of evidence.Nat Rev Neurol. 2010; 6: 256-265
- Independent predictors of ischemic stroke in the elderly: prospective data from a stroke unit.Neurology. 2013; 80: 29-38
- Summary information on a referral opinion following an arbitration pursuant to Article 29 of Directive 2001/83/EC, for Actilyse International Non-Proprietary Name (INN): alteplase.(Available at:) (Accessed October 12, 2014)
- Thrombolysis for acute ischaemic stroke.Cochrane Database Syst Rev. 2014; (CD000213)
- Intravenous thrombolysis for acute cerebral ischaemia in old stroke patients ≥ 80 years of age.J Neurol. 2012; 259: 1461-1467
- Thrombolysis in very elderly people: controlled comparison of SITS International Stroke Thrombolysis Registry and Virtual International Stroke Trials Archive.BMJ. 2010; 341: c6046
- Intravenous TPA for very old stroke patients.Eur Neurol. 2005; 54: 140-144
- Intravenous rt-PA for acute stroke: comparing its effectiveness in younger and older patients.J Neurol Neurosurg Psychiatry. 2005; 76: 1234-1237
- Intravenous thrombolysis with rt-PA in acute ischemic stroke patients aged older than 80 years in Italy.Cerebrovasc Dis. 2008; 25: 129-135
- Canadian Alteplase for Stroke Effectiveness Study (CASES) Investigators: thrombolysis in patients older than 80 years with acute ischaemic stroke: Canadian Alteplase for Stroke Effectiveness Study.J Neurol Neurosurg Psychiatry. 2006; 77: 826-829
- Stroke thrombolysis in England: an age stratified analysis of practice and outcome.Age Ageing. 2013; 42: 240-245
- Intravenous thrombolytic treatment in the oldest old.Stroke Res Treat. 2012; 2012: 923676
- Outcome and severe hemorrhagic complications of intravenous thrombolysis with tissue plasminogen activator in very old (> or = 80 years) stroke patients.Stroke. 2005; 36: 2421-2425
- Intravenous alteplase for stroke in those older than 80 years old.Stroke. 2010; 41: 2568-2574
- Impact of acute ischemic stroke treatment in patients >80 years of age: the specialized program of translational research in acute stroke (SPOTRIAS) consortium experience.Stroke. 2012; 43: 2369-2375
- Comparison of acute nonthrombolytic and thrombolytic treatments in ischemic stroke patients 80 years or older.Am J Emerg Med. 2012; 30: 158-164
- Acute stroke management in the elderly.Cerebrovasc Dis. 2007; 23: 304-308
- Older age does not increase risk of hemorrhagic complications after intravenous and/or intra-arterial thrombolysis for acute stroke.J Stroke Cerebrovasc Dis. 2008; 17: 266-272
- Early neurological improvement after intravenous tissue plasminogen activator infusion in patients with ischemic stroke aged 80 years or older.J Chin Med Assoc. 2014; 77: 179-183
- Outcome of acute ischemic stroke in very elderly patients: is intravenous thrombolysis beneficial?.Eur Neurol. 2011; 66: 110-116
- Age over 80 years is not associated with increased hemorrhagic transformation after stroke thrombolysis.J Clin Neurosci. 2012; 19: 360-363
- Intravenous tissue plasminogen activator for acute ischemic stroke in patients aged 80 years and older: the tPA stroke survey experience.Stroke. 2000; 31: 370-375
- Influence of age on outcome from thrombolysis in acute stroke: a controlled comparison in patients from the Virtual International Stroke Trials Archive (VISTA).Stroke. 2010; 41: 2840-2848
- The benefits and harms of intravenous thrombolysis with recombinant tissue plasminogen activator within 6 h of acute ischaemic stroke (the third international stroke trial [IST-3]): a randomized controlled trial.Lancet. 2012; 379: 2352-2363
- Acute ischemic stroke and transient ischemic attack in the very old—risk factor profile and stroke subtype between patients older than 80 years and patients aged less than 80 years.Eur J Neurol. 2007; 14: 895-899
- Time to treatment with intravenous alteplase and outcome in stroke: an updated pooled analysis of ECASS, ATLANTIS, NINDS, and EPITHET trials.Lancet. 2010; 375: 1695-1703
- Effectiveness of alteplase in the very elderly after acute ischemic stroke.Clin Interv Aging. 2013; 8: 963-974
Article info
Publication history
Published online: April 01, 2016
Accepted:
March 3,
2016
Received in revised form:
February 23,
2016
Received:
December 28,
2015
Identification
DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2016.03.007
Copyright
© 2016 National Stroke Association. Published by Elsevier Inc. All rights reserved.
