title: Intravenous thrombolysis in nonagenarians with ischemic stroke.
abstract: OBJECTIVE
  Demographic changes will result in a rapid increase of patients age ≥90 years (nonagenarians), but little is known about outcomes in these patients after intravenous thrombolysis (IVT) for acute ischemic stroke. We aimed to assess safety and functional outcome in nonagenarians treated with IVT and to compare the outcomes with those of patients age 80 to 89 years (octogenarians).
  
  
  METHODS
  We analyzed prospectively collected data of 284 consecutive stroke patients age ≥80 years treated with IVT in 7 Swiss stroke units. Presenting characteristics, favorable outcome (modified Rankin scale [mRS] 0 or 1), mortality at 3 months, and symptomatic intracranial hemorrhage (SICH) using the National Institute of Neurological Disorders and Stroke (NINDS) and Safe Implementation of Thrombolysis in Stroke-Monitoring Study (SITS-MOST) criteria were compared between nonagenarians and octogenarians.
  
  
  RESULTS
  As compared with octogenarians (n=238; mean age, 83 years), nonagenarians (n=46; mean age, 92 years) were more often women (70% versus 54%; P=0.046) and had lower systolic blood pressure (161 mm Hg versus 172 mm Hg; P=0.035). Patients age ≥90 years less often had a favorable outcome and had a higher incidence of mortality than did patients age 80 to 89 years (14.3% versus 30.2%; P=0.034; and 45.2% versus 22.1%; P=0.002; respectively), while more nonagenarians than octogenarians experienced a SICH (SICH(NINDS), 13.3% versus 5.9%; P=0.106; SICH(SITS-MOST), 13.3% versus 4.7%; P=0.037). Multivariate adjustment identified age ≥90 years as an independent predictor of mortality (P=0.017).
  
  
  CONCLUSIONS
  Our study suggests less favorable outcomes in nonagenarians as compared with octogenarians after IVT for ischemic stroke, and it demands a careful selection for treatment, unless randomized controlled trials yield more evidence for IVT in very old stroke patients.
authors: Neurology Department, University Hospital of Zurich, Frauenklinikstrasse 26, 8091 Zurich, Switzerland. hakan.sarikaya@usz.ch
authors: Hakan
authors: H
authors: Sarikaya
authors: Marcel
authors: M
authors: Arnold
authors: Stefan T
authors: ST
authors: Engelter
authors: Philippe A
authors: PA
authors: Lyrer
authors: Patrik
authors: P
authors: Michel
authors: Céline
authors: C
authors: Odier
authors: Bruno
authors: B
authors: Weder
authors: Barbara
authors: B
authors: Tettenborn
authors: Felix
authors: F
authors: Mueller
authors: Lucka
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authors: Sekoranja
authors: Roman
authors: R
authors: Sztajzel
authors: Pietro
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authors: Ballinari
authors: Heinrich P
authors: HP
authors: Mattle
authors: Ralf W
authors: RW
authors: Baumgartner