title: TPA for ischemic stroke in patients ≥80 years.
abstract: OBJECTIVE
  Although patients >80 years were excluded in RCTs for tPA treatment of acute ischemic stroke (AIS), many centers treat old patients. We wanted to examine whether age ≥80 years is an independent predictor of outcome after tPA.
  
  
  METHODS
  We included 77 consecutive patients ≥80 years and 83 patients <80 years treated with tPA within 4.5 h after onset of AIS. Baseline variables were analyzed by multiple stepwise logistic regression analyses against three outcomes: symptomatic intracerebral hemorrhage (sICH), death and good functional outcome (mRS, 0-1) at 3-month follow-up.
  
  
  RESULTS
  Age ≥80 years was associated with increased risk of sICH (OR, 18.2 [95% CI, 1.0-324.1], P = 0.048), and death (OR, 3.3 [95% CI, 1.2-9.1], P = 0.018), but not with functional outcome at 3 months. Other factors associated with death were longer onset to treatment time (OTT) (OR, 1.007/min increase [95% CI, 1.00-1.015], P = 0.047), higher NIHSS (OR, 1.12 per point increase [95% CI, 1.04-1.19], P = 0.001), and previous stroke (OR, 4.0 [95% CI, 1.2-13.7], P = 0.03). Predictors of good functional outcome were shorter OTT (OR, 0.99 [95% CI, 0.98-1.00], P = 0.02) and lower NIHSS (OR, 0.80 [95% CI, 0.74-0.87] P ≤ 0.001).
  
  
  CONCLUSIONS
  Age ≥80 years might be an independent risk factor for sICH and death the first 3 months after treatment with tPA for AIS, but does not influence the chance of a good functional outcome. We suggest to treat patients over 80 years with tPA, but be cautious if the time from onset (OTT) is long.
authors.affiliation: Department of Neurology, Sørlandet Hospital, Kristiansand, Norway. endre.henriksen@sshf.no
authors.forename: E H
authors.initials: EH
authors.lastname: Henriksen
authors.forename: U
authors.initials: U
authors.lastname: Ljøstad
authors.forename: A
authors.initials: A
authors.lastname: Tveiten
authors.forename: H
authors.initials: H
authors.lastname: Naess
authors.forename: L
authors.initials: L
authors.lastname: Thomassen
authors.forename: A
authors.initials: A
authors.lastname: Mygland
mesh_terms: D000208:Acute Disease; D000367:Age Factors; D017668:Age of Onset; D000369:Aged, 80 and over; D001925:Brain Damage, Chronic / Q000453:epidemiology / Q000209:etiology; D002545:Brain Ischemia / Q000188:drug therapy* / Q000453:epidemiology; D002543:Cerebral Hemorrhage / Q000139:chemically induced; D015897:Comorbidity; D004630:Emergencies; D005260:Female; D005343:Fibrinolytic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009664:Norway / Q000453:epidemiology; D011379:Prognosis; D011446:Prospective Studies; D020127:Recovery of Function; D012307:Risk Factors; D012720:Severity of Illness Index; D015912:Thrombolytic Therapy / Q000009:adverse effects; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000009:adverse effects / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator