Intravenous thrombolysis for acute ischaemic stroke in the elderly: data from the Baden-Wuerttemberg stroke registry.
OBJECTIVE
In Europe intravenous thrombolysis (IVT) for ischaemic stroke is still not approved for patients aged >80 years. However, elderly patients are frequently treated based on individual decision making. In a retrospective observational study a consecutive and prospective stroke registry in southwest Germany was analysed.


METHODS
The data registry collected 101,349 patients with ischaemic stroke hospitalized from January 2008 to December 2012. Of these, 38,575 (38%) were aged 80 years and older and 10 286 (10.1%) underwent IVT. Favourable outcome at discharge was defined as modified Rankin Scale (mRS) ≤1 or not worse than prior to stroke. Multiple logistic regression models stratified by 10-year age groups were used to assess the relationship between IVT and mRS at discharge, adjusted for patient characteristics, admitting facility and length of hospital stay.


RESULTS
The highest IVT rate was 15% in patients aged <50 years, with a continuous decline down to 8% in patients aged ≥90 years. Adjusted odds ratios and 95% confidence intervals for patients 80-89 years of age were 2.20 (1.95-2.47) (P < 0.0001) and 1.25 (0.88-1.78) (P = 0.21) for patients >90 years of age, compared to patients of the same age decade not treated with IVT.


CONCLUSIONS
The evidence from routine hospital care in southwest Germany indicates that IVT is an effective treatment also for aged patients with ischaemic stroke in an age range between 80 and 89 years. Although no clear evidence for the effectiveness of IVT beyond 90 years was found, treatment should also be carefully considered in these patients. High age should not discourage from treatment.
Department of Neurology, Universitätsmedizin Mannheim, University of Heidelberg, Mannheim, Germany.|Department of Neurology, University Hospital Freiburg, University of Freiburg, Freiburg, Germany.
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B
Reuter
Department of Neurology, University of Heidelberg, Heidelberg, Germany.
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C
Gumbinger
Department of Neurology, Universitätsmedizin Mannheim, University of Heidelberg, Mannheim, Germany.
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T
Sauer
(formerly) Department of Neurology, Bürgerhospital, Stuttgart, Germany.
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H
Wiethölter
Office for Quality Assurance in Hospitals (GeQiK), Baden-Wuerttembergische Hospital Association, Stuttgart, Germany.
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I
Bruder
Office for Quality Assurance in Hospitals (GeQiK), Baden-Wuerttembergische Hospital Association, Stuttgart, Germany.
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S
Rode
Department of Neurology, University of Heidelberg, Heidelberg, Germany.
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PA
Ringleb
Department of Neurology, Universitätsmedizin Mannheim, University of Heidelberg, Mannheim, Germany.
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R
Kern
Department of Neurology, University of Heidelberg, Heidelberg, Germany.
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W
Hacke
Department of Neurology, Universitätsmedizin Mannheim, University of Heidelberg, Mannheim, Germany.
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MG
Hennerici
D061605:Administration, Intravenous; D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000188:drug therapy*; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data*; D012042:Registries; D012189:Retrospective Studies; D020521:Stroke / Q000188:drug therapy*; D015912:Thrombolytic Therapy / Q000706:statistics & numerical data*
acute stroke; age; epidemiology of stroke; stroke unit concept; thrombolytic therapy