title: Outcome of acute ischemic stroke in very elderly patients: is intravenous thrombolysis beneficial?
abstract: OBJECTIVE
  Intravenous tissue plasminogen activator (tPA) treatment is recommended in acute stroke within 3 h of onset; however, the benefit of its use in the elderly remains uncertain. We assessed the safety and efficacy of tPA treatment in elderly patients.
  
  
  METHODS
  We recruited 97 elderly Chinese patients aged ≥80 years with cerebral ischemia presenting within 3 h of onset. Favorable outcomes were defined as discharge to home and modified Rankin Scale (mRS) ≤2 at discharge.
  
  
  RESULTS
  For moderate to severe patients (NIHSS ≥6), the baseline characteristics between the tPA (n = 30) and non-tPA (n = 41) group were not different. The proportion of patients discharged home was 56.7 and 61%, respectively (p = 0.72). For patients with baseline mRS ≤2, the frequency of discharged mRS ≤2 was not different (27.3% of the tPA group and 26.9% of the non-tPA group; p = 1.00). Symptomatic intracranial hemorrhage was 6.7 and 2.4%, respectively (p = 0.31). For minor stroke patients (NIHSS ≤5), tPA was not considered and the outcome of those discharged home and mRS ≤2 was 73 and 88%, respectively.
  
  
  CONCLUSIONS
  Elderly patients can be treated safely with intravenous tPA, whereas our data did not support routine thrombolysis. Further randomized trials in the elderly are encouraged.
authors.affiliation: Department of Neurology, College of Medicine, National Cheng Kung University, Tainan, Taiwan, ROC.
authors.forename: Pi-Shan
authors.initials: PS
authors.lastname: Sung
authors.forename: Chih-Hung
authors.initials: CH
authors.lastname: Chen
authors.forename: Han-Chieh
authors.initials: HC
authors.lastname: Hsieh
authors.forename: Chen-Wen
authors.initials: CW
authors.lastname: Fang
authors.forename: Cheng-Yang
authors.initials: CY
authors.lastname: Hsieh
authors.forename: Yuan-Ting
authors.initials: YT
authors.lastname: Sun
authors.forename: Wen-Juh
authors.initials: WJ
authors.lastname: Hwang
mesh_terms: D000369:Aged, 80 and over; D001921:Brain / Q000378:metabolism / Q000473:pathology; D005260:Female; D006801:Humans; D007275:Injections, Intravenous; D002546:Ischemic Attack, Transient / Q000188:drug therapy*; D008297:Male; D009460:Neurologic Examination; D012189:Retrospective Studies; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D020521:Stroke / Q000188:drug therapy*; D015912:Thrombolytic Therapy / Q000379:methods*; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D010959:Tissue Plasminogen Activator