title: Influence of age on thrombolysis outcome in wake-up stroke.
abstract: OBJECTIVE
  Thrombolysis in patients >80 years remains controversial; we hypothesized that >80-year-old patients with wake-up ischemic stroke (WUIS) will benefit from thrombolysis despite risks because of poor outcomes with no treatment.
  
  
  METHODS
  The study included 68 thrombolysed patients with WUIS (33 [48%] >80 years), 54 nonthrombolysed patients with WUIS (21 [39%] >80 years), and 117 patients (>80 years old) thrombolysed within 4.5 hours of symptom onset (reference group). Mortality and modified Rankin Scale (mRS) were assessed at 90 days.
  
  
  RESULTS
  Baseline characteristics of thrombolysed and nonthrombolysed >80 and ≤80-year-old patients with WUIS were comparable. Thrombolysis outcomes in >80-year-old patients with WUIS were better than in nonthrombolysed >80-year-old patients with WUIS (90-day mortality: 24% versus 47%, P=0.034; mRS 0-2: 30% versus 5%, P=0.023; mRS 0-1: 15% versus 5%, P=0.24) and comparable with thrombolysed ≤80-year-old patients with WUIS. Thrombolysis was associated with odds ratio 0.27 (95% confidence interval, 0.05-0.97) for mortality and odds ratio 28.6 (95% confidence interval, 1.8-448) for mRS 0 to 2 at 90 days in >80-year-old patients with WUIS after adjusting for stroke severity and risk factors.
  
  
  CONCLUSIONS
  Thrombolysis may be associated with greater benefit in >80-year-old patients with WUIS but a selection bias favoring thrombolysis in those most likely to benefit may significantly reduce interpretability of these findings.
authors.affiliation: From the Department of Clinical Neuroscience, King's College London, United Kingdom (D.M., S.B., L.K.); and Acute and Emergency Medicine, King's College Hospital NHS Trust, London, United Kingdom (D.M., J.K.).
authors.forename: Dulka
authors.initials: D
authors.lastname: Manawadu
authors.forename: Shankaranand
authors.initials: S
authors.lastname: Bodla
authors.forename: Jeff
authors.initials: J
authors.lastname: Keep
authors.forename: Lalit
authors.initials: L
authors.lastname: Kalra
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging; D002545:Brain Ischemia / Q000401:mortality* / Q000628:therapy*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012042:Registries; D020521:Stroke / Q000401:mortality* / Q000628:therapy*; D015996:Survival Rate; D015912:Thrombolytic Therapy; D013997:Time Factors
keywords: aging; outcomes; stroke management; thrombolysis; wake-up stroke