Thrombolytic therapy for acute ischaemic stroke in octogenarians: selection by magnetic resonance imaging improves safety but does not improve outcome.
BACKGROUND
Owing to the fear of an increased bleeding risk, thrombolytic therapy is withheld from many patients with acute stroke > 80 years of age.


OBJECTIVE
To analyse the risk for symptomatic intracranial haemorrhage (sICH), morbidity and mortality after thrombolytic therapy in octogenarians focusing, in particular, on whether patients selected using magnetic resonance imaging (MRI) had a better risk:benefit ratio.


METHODS
The prospectively collected single-centre data of all patients treated with systemic thrombolytic therapy for acute ischaemic stroke since 1998 (n = 468) were reviewed, and patients > or = 80 years (n = 90) were compared with those aged < 80 years (n = 378). In addition, the group of octogenarians was analysed with respect to initial imaging modality.


RESULTS
The overall rate of sICH in the octogenarians was 6.9%, compared with 5.3% in younger patients (p = 0.61). In older patients selected by computed tomography, the rate of sICH was 9.4%; no patient selected by MRI had sICH (p = 0.10). Mortality in the octogenarians selected by computed tomography was 29.7% after 3 months as compared with 26.9% in the patients selected by MRI (p = 1.0). 20.3% of the octogenarians selected by computed tomography and 15.4% of those selected by MRI had a favourable outcome (modified Rankin scale < or = 1) after 3 months (p = 0.77).


CONCLUSIONS
Compared with younger patients, octogenarians do not have an increased risk of sICH. The use of MRI to select octogenarians for thrombolytic therapy seemed to decrease the risk of sICH, but did not influence the overall outcome after 3 months.
Ringleb
P A
PA
Neurologische Klinik der Ruprecht-Karls-Universität Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany. peter.ringleb@med.uni-heidelberg.de
Schwark
Ch
Ch
Köhrmann
M
M
Külkens
S
S
Jüttler
E
E
Hacke
W
W
Schellinger
P D
PD
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology*; D002543:Cerebral Hemorrhage / Q000139:chemically induced; D000075202:Contraindications; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012306:Risk; D020521:Stroke / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology*; D015912:Thrombolytic Therapy / Q000009:adverse effects*; D016896:Treatment Outcome