Intravenous thrombolysis with rt-PA in acute ischemic stroke patients aged older than 80 years in Italy.
BACKGROUND
Intravenous (i.v.) thrombolysis with rt-PA within 3 h from symptom onset is the only approved treatment of pharmacological revascularization in acute ischemic stroke. However, little information exists on its use in elderly patients, in particular those aged >80 years, who at present are excluded from treatment.


METHODS
In a multicenter Italian study on i.v. thrombolysis, patients aged >80 years (n = 41) were compared with those aged <or=80 years (n = 207) regarding the percentage of symptomatic (nonfatal and fatal) intracerebral hemorrhage (SICH), favorable 3-month functional outcome (modified Rankin Scale score 0-2) and poor outcome (death or dependence, i.e. modified Rankin Scale score 3-5).


RESULTS
The percentage of SICH (nonfatal and fatal) was comparable between older (2.4%, 2.4%) and younger (2.4%, 2.4%) patient groups (p = 1.0). At 3 months, favorable outcome occurred in 44% and dependence in 22% of the older, and respectively in 58.5 and in 30.9% of the younger patients (p = 0.897). Patients aged >80 years had a higher mortality (34.1%) as compared to those aged <or=80 years (10.6%) (p < 0.001). Baseline National Institute of Health Stroke Scale score was the only statistically significant predictor of both mortality (OR = 1.26; 95% CI = 1.07-1.50) and poor outcome (OR = 1.39; 95% CI = 1.14-1.68) in the >80-year-old group.


CONCLUSIONS
Acute ischemic stroke patients aged >80 years treated with i.v. rt-PA have a higher mortality than younger patients, but there are no differences for SICH nor for favorable outcome. Our data suggest that thrombolytic therapy should not be a priori denied for appropriately selected >80-year-old patients but randomized controlled clinical trials are necessary before definite recommendations can be given.
Toni
Danilo
D
Unità di Trattamento Neurovascolare, Department of Neurological Sciences, University of Rome La Sapienza, Rome, Italy. danilo.toni@uniroma1.it
Lorenzano
Svetlana
S
Agnelli
Giancarlo
G
Guidetti
Donata
D
Orlandi
Giovanni
G
Semplicini
Andrea
A
Toso
Vito
V
Caso
Valeria
V
Malferrari
Giovanni
G
Fanucchi
Simona
S
Bartolomei
Luigi
L
Prencipe
Massimiliano
M
D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000150:complications / Q000188:drug therapy*; D015331:Cohort Studies; D005343:Fibrinolytic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D007262:Infusions, Intravenous; D020300:Intracranial Hemorrhages / Q000139:chemically induced; D007558:Italy; D008875:Middle Aged; D011994:Recombinant Proteins; D020521:Stroke / Q000188:drug therapy* / Q000209:etiology; D015912:Thrombolytic Therapy; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage* / Q000009:adverse effects; D016896:Treatment Outcome
D005343:Fibrinolytic Agents; D011994:Recombinant Proteins; D010959:Tissue Plasminogen Activator