Thrombolysis in patients older than 80 years with acute ischaemic stroke: Canadian Alteplase for Stroke Effectiveness Study.
BACKGROUND
The benefit of intravenous tissue plasminogen activator (tPA) given within 3 h of acute ischaemic stroke to patients over 80 years of age is uncertain.


OBJECTIVE
To examine the clinical characteristics and complications and the predictors of outcome after intravenous tPA treatment in patients aged > or = 80 years.


METHODS
Data (n = 1135) prospectively collected from the Canadian Alteplase for Stroke Effectiveness Study were reviewed and patients aged > or = 80 years (n = 270) treated with intravenous tPA for acute ischaemic stroke were compared with those aged <80 years (n = 865).


RESULTS
The risk of symptomatic intracerebral haemorrhage did not differ between patients aged > or = 80 years and <80 years (4.4% (95% CI 2.3 to 7.6) v 4.6% (95% CI 3.3 to 6.2), p = 1.0). Favourable outcome, defined as a modified Rankin Score of 0-1 at 90 days, was seen in 26% of patients aged > or = 80 years and in 40% of those <80 (p<0.001). The following baseline characteristics were found to be more common in those aged > or = 80 years than in those aged <80 years: atrial fibrillation (37% v 18%; p<0.001); congestive heart failure (11% v 6%; p = 0.004); hypertension (59% v 48%; p = 0.002); and severity of stroke with a median National Institutes of Health Stroke Scale (NIHSS) score of 16 v 14 (p = 0.004). In the multivariable logistic regression analysis, age > or = 80 years, stroke severity, baseline Alberta Stroke Program Early CT Score and glucose level were found to be the major independent predictors of outcome.


CONCLUSIONS
In carefully selected elderly patients, the use of intravenous tPA was not found to be associated with an increased risk of symptomatic intracerebral haemorrhage. Age-related differences were seen in the clinical characteristics and outcome in the elderly population.
Sylaja
P N
PN
Calgary Stroke Program, Department of Clinical Neurosciences, Foothills Hospital, Room 1242A, Calgary, AB T2N 2T9, Canada.
Cote
Robert
R
Buchan
Alastair M
AM
Hill
Michael D
MD
D000208:Acute Disease; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000150:complications / Q000188:drug therapy*; D000075202:Contraindications; D005260:Female; D005343:Fibrinolytic Agents / Q000009:adverse effects* / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011379:Prognosis; D011446:Prospective Studies; D020521:Stroke / Q000150:complications / Q000188:drug therapy*; D015912:Thrombolytic Therapy; D010959:Tissue Plasminogen Activator / Q000009:adverse effects* / Q000627:therapeutic use*; D016896:Treatment Outcome
D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator