title: Intravenous thrombolysis in patients aged more than 80 years in the three rural hospitals in southeast Poland: an observational study.
abstract: OBJECTIVE
  Approximately 30% of acute ischemic stroke (AIS) occurs in people aged over 80 years. Older patients are increasingly receiving intravenous thrombolysis (IV-thrombolysis) for AIS; however, the majority of treatments are carried out in urban hospitals. The aim of the present study was to assess the safety and effectiveness of IV-thrombolysis in patients aged older than 80 years.
  
  
  METHODS
  We retrospectively evaluated the clinical and epidemiological data of 409 patients with AIS who were consecutively treated with IV-thrombolysis from September 2006 to June 2012 in the three rural hospitals.
  
  
  RESULTS
  In the analyzed group, there were 22.3% of patients who were aged over 80 years (2.4% patients aged ≥ 90 years). Among these patients we found: longer onset to door time (P = 0.04), onset to treatment time (P = 0.0003) and door to treatment time (P < 0.0001). The functional independence (modified Rankin Scale 0-2) at 90 days was lower (P = 0.0004), whereas the risk of hemorrhagic transformation (HT; P = 0.001), symptomatic intracerebral hemorrhage (SICH) according to National Institute of Neurological Disorders and Stroke (NINDS) definition (P = 0.003) and mortality rate within 3 months were higher (P < 0.0001) than in younger patients. A multivariate analysis showed no impact of older age on long-term outcome, and the presence of HT and SICH. Age over 80 years was associated with higher mortality rate.
  
  
  CONCLUSIONS
  Older age affected the increased times for pre- and in-hospital procedures in rural patients with AIS. Older patients should not be denied the chance to benefit from IV-thrombolysis, but because of the higher mortality, the application of this therapy should be carefully decided on.
authors.affiliation: Department of Neurology and Stroke Unit, Holy Spirit Specialist Hospital in Sandomierz, Sandomierz, Poland.
authors.forename: Piotr
authors.initials: P
authors.lastname: Sobolewski
authors.forename: Waldemar
authors.initials: W
authors.lastname: Brola
authors.forename: Jan
authors.initials: J
authors.lastname: Stoiński
authors.forename: Wiktor
authors.initials: W
authors.lastname: Szczuchniak
authors.forename: Malgorzata
authors.initials: M
authors.lastname: Fudala
authors.forename: Renata
authors.initials: R
authors.lastname: Hatalska-Żerebiec
authors.forename: Monika
authors.initials: M
authors.lastname: Sledzińska-Dźwigał
mesh_terms: D000367:Age Factors; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000150:complications / Q000188:drug therapy* / Q000401:mortality; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage*; D006780:Hospitals, Rural; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D011044:Poland; D012189:Retrospective Studies; D020521:Stroke / Q000188:drug therapy* / Q000209:etiology / Q000401:mortality; D015912:Thrombolytic Therapy; D061665:Time-to-Treatment; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents
keywords: intravenous thrombolysis; ischemic stroke; patients over 80 years; rural hospitals