Thrombolytic therapy for acute stroke in the elderly: an emergent condition in developing countries.
Elderly patients may represent an important group when considering new stroke treatments, particularly in developing countries. The aim of this study was to analyze the use of recombinant tissue plasminogen activator (rtPA) in elderly Brazilian patients with acute ischemic stroke. Clinical and neuroimaging parameters at admission, frequency of symptomatic intracranial hemorrhage, and outcome were compared between elderly (≥80 years) and nonelderly (<80 years) stroke patients treated with rtPA in the Porto Alegre Stroke Network. We evaluated 183 nonelderly patients (mean age, 63 ± 12 years) and 55 elderly patients (mean age, 84 ± 3 years). Female sex, hypertension, congestive heart failure, atrial fibrillation, and previous history of stroke or transient ischemic attack were more frequent in the elderly patients. Elderly patients also presented with higher mean systolic blood pressure (P = .03) and National Institutes of Health Stroke Scale (NIHSS) score (P < .0001), whereas the nonelderly patients had a higher serum glucose level (P = .03). The rate of symptomatic intracranial hemorrhage was 10.9% in the elderly patients and 6.6% in the nonelderly patients (P = .28), and a substantial proportion of the elderly patients achieved a favorable outcome (modified Rankin Scale score ≤1) at 90 days, although this proportion was lower than that in the nonelderly patients (42% vs 58%; P = .04). Poorer outcomes were generally seen in elderly patients with an anterior circulation stroke, a higher NIHSS score, hypoattenuation in ≥1/3 lf the middle cerebral artery territory, and an Alberta Stroke Program Early CT score of ≤7 on an initial computed tomography scan. Our results support the administration of intravenous rtPA in selected elderly stroke patients presenting early to the hospital in developing countries.
Martins
Sheila Cristina Ouriques
SC
Vascular Unit, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil; Vascular Care Unit, Hospital Mãe de Deus, Porto Alegre, Brazil. smartins@portoweb.com.br
Friedrich
Maurício André Gheller
MA
Brondani
Rosane
R
de Almeida
Andrea Garcia
AG
de Araújo
Mariana D'Agnino
MD
Chaves
Márcia Lorena Fagundes
ML
Berger
Joseph Robert
JR
Massaro
Ayrton Roberto
AR
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging; D001938:Brazil / Q000453:epidemiology; D016009:Chi-Square Distribution; D003906:Developing Countries; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006299:Health Services for the Aged; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011446:Prospective Studies; D011994:Recombinant Proteins / Q000627:therapeutic use; D012044:Regression Analysis; D018570:Risk Assessment; D012307:Risk Factors; D020521:Stroke / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality; D015912:Thrombolytic Therapy; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*; D016896:Treatment Outcome
D005343:Fibrinolytic Agents; D011994:Recombinant Proteins; D010959:Tissue Plasminogen Activator