title: Early neurological improvement after intravenous tissue plasminogen activator infusion in patients with ischemic stroke aged 80 years or older.
abstract: BACKGROUND
  Early neurological improvement has been observed in patients with stroke receiving treatment with standard intravenous recombinant tissue plasminogen activator. However, the effectiveness of thrombolytic treatment and the risk of hemorrhagic transformation are not well understood in patients aged ≥ 80 years. In this study, we investigated the influence of age on early neurological improvement and hemorrhagic transformation rates in patients with stroke aged ≥ 80 years and receiving recombinant tissue plasminogen activator.
  
  
  METHODS
  The study included 157 patients who received recombinant tissue plasminogen activator infusion at a teaching hospital. The National Institutes of Health Stroke Scale was used to evaluate stroke severity. Early neurological improvement was defined as an improvement of 8 or more points on this scale (compared with baseline) 24 hours after thrombolytic treatment. Neurological improvement was defined as an improvement of 8 or more points (compared with baseline) at discharge. Neurological deterioration was defined as an increase of 4 or more points (compared with baseline). Multivariate analysis was used to evaluate the associations among age, neurological improvement, and hemorrhagic transformation.
  
  
  RESULTS
  The rate of early neurological improvement was 36.9% (58/157 patients) and the rate of hemorrhagic transformation was 22.3% (35/157 patients). At discharge, the rate of neurological improvement was 50.9% (80/157 patients) and the rate of neurological deterioration was 13.4% (21/157 patients). There was no statistically significant difference between patients aged ≥ 80 years and those <80 years of age with respect to rates of early neurological improvement, neurological deterioration, or hemorrhagic transformation. Among patients ≥ 80 years, the rate of neurological improvement in those receiving thrombolytic treatment was higher than the rate in those patients not receiving thrombolytic treatment (58.8% vs. 14.1%, p < 0.01). We concluded that thrombolysis increases the rate of neurological improvement in patients aged ≥ 80 years.
  
  
  CONCLUSIONS
  In older patients, thrombolytic treatment increased the rate of neurological improvement compared with patients not receiving the treatment. The study showed that thrombolytic treatment may be beneficial for patients ≥80 years, but should be performed with extreme care.
authors.affiliation: Department of Neurology, Ditmanson Medical Foundation, Chia-Yi Christian Hospital, Chia-Yi, Taiwan, ROC; Department of Nursing, Chung Jen Junior College of Nursing, Health Science and Management, Chia-Yi, Taiwan, ROC. Electronic address: ctong98@yahoo.com.tw.
authors.forename: Cheung-Ter
authors.initials: CT
authors.lastname: Ong
authors.affiliation: Department of Neurology, Ditmanson Medical Foundation, Chia-Yi Christian Hospital, Chia-Yi, Taiwan, ROC.
authors.forename: Sheng-Feng
authors.initials: SF
authors.lastname: Sung
authors.affiliation: Department of Neurology, Ditmanson Medical Foundation, Chia-Yi Christian Hospital, Chia-Yi, Taiwan, ROC.
authors.forename: Chi-Shun
authors.initials: CS
authors.lastname: Wu
authors.affiliation: Department of Neurology, Ditmanson Medical Foundation, Chia-Yi Christian Hospital, Chia-Yi, Taiwan, ROC.
authors.forename: Yung-Chu
authors.initials: YC
authors.lastname: Hsu
authors.affiliation: Department of Neurology, Ditmanson Medical Foundation, Chia-Yi Christian Hospital, Chia-Yi, Taiwan, ROC.
authors.forename: Yu-Hsiang
authors.initials: YH
authors.lastname: Su
authors.affiliation: Department of Neurology, Ditmanson Medical Foundation, Chia-Yi Christian Hospital, Chia-Yi, Taiwan, ROC.
authors.forename: Chen-Hsien
authors.initials: CH
authors.lastname: Li
authors.affiliation: Department of Neurology, Ditmanson Medical Foundation, Chia-Yi Christian Hospital, Chia-Yi, Taiwan, ROC.
authors.forename: Ling-Chien
authors.initials: LC
authors.lastname: Hung
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D011994:Recombinant Proteins / Q000008:administration & dosage; D020521:Stroke / Q000188:drug therapy* / Q000503:physiopathology*; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage*; D016896:Treatment Outcome
chemical_list: D011994:Recombinant Proteins; D010959:Tissue Plasminogen Activator
keywords: cardioembolism; hemorrhagic transformation; ischemic stroke; outcomes; thrombolytic treatment