title: Outcome of intravenous recombinant tissue plasminogen activator for acute ischemic stroke in patients aged over 80 years.
abstract: OBJECTIVE
  Practitioners are faced with a substantial challenge when considering recombinant tissue plasminogen activator (rt-PA) therapy for older patients with ischemic stroke. Patients aged over 80 years suffer from the most severe cerebral infarcts. The benefit of rt-PA treatment compared with single standard care only in stroke units remains to be clearly assessed.
  
  
  METHODS
  We collected data from 321 patients aged over 80 years admitted for acute cerebral infarction to the stroke unit of Nancy University Hospital in France between 1 January 2009 and 31 December 2012. Patients were stratified into two groups: treated or not with rt-PA. Baseline characteristics and outcome were collected and compared between both groups. Good outcome at 3 months was defined as modified Rankin Scale score ≤2.
  
  
  RESULTS
  The 55 patients treated with rt-PA had a higher National Institute of Health Stroke Scale score on admission than those without (15 vs 5; P < 0.001). They were more likely to have intracranial haemorrhage (20 vs 5%; P < 0.001) without an increased mortality rate (28 vs 27%; P = 0.95). Multivariate analysis showed a more favorable outcome (odds ratio 7, 95% confidence interval 3-16.5; P < 0.001). Slightly higher percentages of patients with modified Rankin Scale ≤2 were found after intention-to-treat analysis (49 vs 45%) and after exclusion of patients with baseline modified Rankin Scale >2 (57 vs 54 %), but without reaching significance (P > 0.05).
  
  
  CONCLUSIONS
  Rt-PA therapy would appear to improve prognosis in the elderly with ischemic stroke. This suggests that age alone should no longer be a barrier to rt-PA therapy. Geriatr Gerontol Int 2016; 16: 843-849.
authors.affiliation: Department of Neurology, Stroke unit, University Hospital of Nancy, Nancy, France.
authors.forename: Gioia
authors.initials: G
authors.lastname: Mione
authors.affiliation: Department of Neurology, Stroke unit, University Hospital of Nancy, Nancy, France.
authors.forename: Xavier
authors.initials: X
authors.lastname: Ducrocq
authors.affiliation: Department of Clinical Epidemiology and Evaluation, CIC-EC CIE6 Inserm, University Hospital of Nancy, Nancy, France.
authors.forename: Nathalie
authors.initials: N
authors.lastname: Thilly
authors.affiliation: Department of Neurology, Stroke unit, University Hospital of Nancy, Nancy, France.
authors.forename: Jean-Christophe
authors.initials: JC
authors.lastname: Lacour
authors.affiliation: Department of Neurology, Stroke unit, University Hospital of Nancy, Nancy, France.
authors.forename: Hervé
authors.initials: H
authors.lastname: Vespignani
authors.affiliation: Department of Neurology, Stroke unit, University Hospital of Nancy, Nancy, France.
authors.forename: Sébastien
authors.initials: S
authors.lastname: Richard
mesh_terms: D061605:Administration, Intravenous; D000367:Age Factors; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000188:drug therapy* / Q000209:etiology / Q000401:mortality; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D020521:Stroke / Q000188:drug therapy* / Q000209:etiology / Q000401:mortality; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator
keywords: elderly patients; ischemic stroke; old patients; outcome; recombinant tissue plasminogen activator; stroke thrombolysis