Intravenous thrombolysis for acute ischaemic stroke in young adult patients.
BACKGROUND
Intravenous tissue plasminogen activator (IV tPA) has been studied primarily in patients over age 50. We sought to describe baseline differences in adult patients < or = 50 years-old taken from a large prospective cohort of acute stroke patients treated with intravenous tPA (IV tPA) and to determine whether outcomes differed for this population.


METHODS
Data (n = 1120) prospectively collected from the Canadian Alteplase for Stroke Effectiveness Study (CASES) were reviewed and patients aged < or = 50 years-old (n = 99) were compared with those aged > 50 years (n = 1021) with regards to baseline characteristics, symptomatic intracerebral haemorrhage (sICH), functional outcome at 90 days and death.


RESULTS
Nine percent of patients were < or = 50 years-old. Among patients aged < or = 50 years, 40.4% were women and median age was 42 +/- 6.1 years (range 20 to 50). They had significantly more current cigarette use but fewer other vascular risk factors than older patients (p < 0.05) and their baseline median NIHSS score was lower (13 versus 15, P = 0.001). Although this group was more likely to have a favourable 90-day outcome, multivariable regression confirmed that age < or = 50 years, while independently associated with a decreased risk of death (RR 0.36, 95% CI 0.14 to 0.95), was not itself predictive of favourable 90-day outcome or decreased risk of sICH.


CONCLUSIONS
Adult patients < or = 50 years-old had fewer medical co-morbidities and a modestly lower baseline median NIHSS score than their older counterparts. Age < or = 50 years was independently associated with a decreased risk of death but not with favourable outcome or risk of sICH.
Poppe
Alexandre Y
AY
Calgary Stroke Program, University of Calgary, Foothills Medical Centre, Calgary, Alberta, Canada.
Buchan
Alastair M
AM
Hill
Michael D
MD
D000328:Adult; D000368:Aged; D015897:Comorbidity; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage*; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D020521:Stroke / Q000188:drug therapy* / Q000453:epidemiology; D015912:Thrombolytic Therapy; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage*
D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator