Comparison of acute nonthrombolytic and thrombolytic treatments in ischemic stroke patients 80 years or older.
OBJECTIVE
The aim of this study was to compare the clinical outcomes of acute ischemic stroke patients 80 years or older treated with intravenous recombinant tissue plasminogen activator (i.v. rt-PA), or endovascular intervention with or without i.v. rt-PA, or nonthrombolytic medical treatment.


METHODS
This study was a retrospective, nonrandomized, observational study of patients, admitted within 9 hours of symptom onset, at 3 academic, university-affiliated hospitals. The main outcome measures were neurologic improvement, defined by improvement in National Institutes of Health Stroke Scale score at 7 days or discharge of 4 or more, or achieving a score of 0; symptomatic and asymptomatic intracerebral hemorrhage; favorable outcome (discharge modified Rankin score 0-2); and in-hospital mortality.


RESULTS
A total of 44 patients received i.v. rt-PA, 46 received endovascular intervention with or without i.v. rt-PA, and 66 received nonthrombolytic medical treatment. I.v. rt-PA-treated patients had a significantly clinically higher chance of favorable outcome (odds ratio [OR], 5.6; 95% confidence interval [CI], 1.8-17.5), when compared with nonthrombolytic medical treatment. A significantly higher rate of neurologic improvement was observed among the i.v. rt-PA (7.2; 95% CI, 2.7-19.5) and endovascularly treated patients (5.8; 95% CI, 2-16.8) when compared with nonthrombolytic medical treatment.


CONCLUSIONS
A prominently higher rate of neurologic improvement and favorable clinical outcome was observed among acute ischemic stroke patients 80 years or older treated with i.v. rt-PA or endovascular intervention when compared with nonthrombolytic medical treatment, supporting the use of acute thrombolytic therapies in this patient population when contraindications are not present.
Zeenat Qureshi Stroke Research Center, University of Minnesota, Minneapolis, MN 55455, USA.
Haralabos
H
Zacharatos
Ameer E
AE
Hassan
Gabriela
G
Vazquez
Haitham M
HM
Hussein
Gustavo J
GJ
Rodriguez
M Fareed K
MF
Suri
Kamakshi
K
Lakshminarayan
Mustapha A
MA
Ezzeddine
Adnan I
AI
Qureshi
D000369:Aged, 80 and over; D020520:Brain Infarction / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D016009:Chi-Square Distribution; D057510:Endovascular Procedures; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006801:Humans; D016015:Logistic Models; D008297:Male; D011994:Recombinant Proteins / Q000627:therapeutic use; D012189:Retrospective Studies; D015912:Thrombolytic Therapy; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*; D016896:Treatment Outcome
D005343:Fibrinolytic Agents; D011994:Recombinant Proteins; D010959:Tissue Plasminogen Activator