title: Thrombolysis in very elderly people: controlled comparison of SITS International Stroke Thrombolysis Registry and Virtual International Stroke Trials Archive.
abstract: OBJECTIVE
  To assess effect of age on response to alteplase in acute ischaemic stroke.
  
  
  METHODS
  Adjusted controlled comparison of outcomes between non-randomised patients who did or did not undergo thrombolysis. Analysis used Cochran-Mantel-Haenszel test and proportional odds logistic regression analysis.
  
  
  METHODS
  Collaboration between International Stroke Thrombolysis Registry (SITS-ISTR) and Virtual International Stroke Trials Archive (VISTA).
  
  
  METHODS
  23 334 patients from SITS-ISTR (December 2002 to November 2009) who underwent thrombolysis and 6166 from VISTA neuroprotection trials (1998-2007) who did not undergo thrombolysis (as controls). Of the 29 500 patients (3472 aged >80 ("elderly," mean 84.6), data on 272 patients were missing for baseline National Institutes of Health stroke severity score, leaving 29 228 patients for analysis adjusted for age and baseline severity.
  
  
  METHODS
  Functional outcomes at 90 days measured by score on modified Rankin scale.
  
  
  RESULTS
  Median severity at baseline was the same for patients who underwent thrombolysis and controls (median baseline stroke scale score: 12 for each group, P=0.14; n=29 228). The distribution of scores on the modified Rankin scale was better among all thrombolysis patients than controls (odds ratio 1.6, 95% confidence interval 1.5 to 1.7; Cochran-Mantel-Haenszel P<0.001). The association occurred independently among patients aged ≤80 (1.6, 1.5 to 1.7; P<0.001; n=25 789) and in those aged >80 (1.4, 1.3 to 1.6; P<0.001; n=3439). Odds ratios were consistent across all 10 year age ranges above 30, and benefit was significant from age 41 to 90; dichotomised outcomes (score on modified Rankin scale 0-1 v 2-6; 0-2 v 3-6; and 6 (death) v rest) were consistent with the results of the ordinal analysis.
  
  
  CONCLUSIONS
  Outcome in patients with acute ischaemic stroke is significantly better in those who undergo thrombolysis compared with those who do not. Increasing age is associated with poorer outcome but the association between thrombolysis treatment and improved outcome is maintained in very elderly people. Age alone should not be a barrier to treatment.
authors.affiliation: Acute Stroke Unit, University Department of Medicine and Therapeutics, Gardiner Institute, Western Infirmary and Faculty of Medicine, University of Glasgow, Glasgow G11 6NT, UK.
authors.forename: Nishant K
authors.initials: NK
authors.lastname: Mishra
authors.forename: Niaz
authors.initials: N
authors.lastname: Ahmed
authors.forename: Grethe
authors.initials: G
authors.lastname: Andersen
authors.forename: José A
authors.initials: JA
authors.lastname: Egido
authors.forename: Perttu J
authors.initials: PJ
authors.lastname: Lindsberg
authors.forename: Peter A
authors.initials: PA
authors.lastname: Ringleb
authors.forename: Nils G
authors.initials: NG
authors.lastname: Wahlgren
authors.forename: Kennedy R
authors.initials: KR
authors.lastname: Lees
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D002543:Cerebral Hemorrhage / Q000150:complications; D002986:Clinical Trials as Topic; D005343:Fibrinolytic Agents / Q000008:administration & dosage*; D006801:Humans; D007262:Infusions, Intravenous; D008875:Middle Aged; D015337:Multicenter Studies as Topic; D012042:Registries; D020521:Stroke / Q000150:complications / Q000188:drug therapy*; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator