title: Thrombolysis in Patients Aged over 80 Years Is Equally Effective and Safe.
abstract: BACKGROUND
  Despite stroke's high prevalence in the elderly, intravenous thrombolysis is licensed in Europe only for patients younger than 80 years old. We aimed to compare the functional outcomes and complication rates in patients older versus younger than 80 years old treated with intravenous thrombolysis.
  
  
  METHODS
  A retrospective observational study of patients who received intravenous thrombolysis in a stroke unit between January 1, 2009, and June 30, 2012, was conducted. Variables were compared between 2 subgroups (≤80 and >80 years).
  
  
  RESULTS
  Overall, 512 patients underwent intravenous thrombolysis, of which 13.1% were over 80 years. The mean age was 65.4 years in the younger subgroup and 82.9 years in the older subgroup. Prior independence rates did not differ between the subgroups. Prevalence of atrial fibrillation and cardioembolic stroke was higher in the older subgroup (P = .004 and .026). Only 3% of the elderly with atrial fibrillation were taking oral anticoagulants. Symptoms-to-needle time was lower in the older subgroup (P = .048). Stroke severity was higher in patients over 80 years (P = .026). There was significant improvement in the National Institutes of Health Stroke Scale score 7 days after intravenous thrombolysis (P < .001) in both subgroups. The proportion of patients with 3 months' favorable outcome and independence, hemorrhagic transformation, and mortality rates were similar in both subgroups.
  
  
  CONCLUSIONS
  Elderly patients' benefits and outcomes from intravenous thrombolysis treatment were identical to the younger subgroup without excess hemorrhagic transformation or mortality. These results favor the use of intravenous thrombolysis in patients over 80 years.
authors.affiliation: Medicina 3, Hospital Distrital de Santarém, Cartaxo, Portugal. Electronic address: petrapego@gmail.com.
authors.forename: Petra M
authors.initials: PM
authors.lastname: Pego
authors.affiliation: Unidade CerebroVascular, Hospital de São José, Lisboa, Portugal.
authors.forename: Ana Paiva
authors.initials: AP
authors.lastname: Nunes
authors.affiliation: Unidade CerebroVascular, Hospital de São José, Lisboa, Portugal.
authors.forename: Patricia
authors.initials: P
authors.lastname: Ferreira
authors.affiliation: Unidade CerebroVascular, Hospital de São José, Lisboa, Portugal.
authors.forename: Cristina
authors.initials: C
authors.lastname: Sousa
authors.affiliation: Unidade CerebroVascular, Hospital de São José, Lisboa, Portugal; Unidade de Neurologia, Hospital Vila Franca de Xira, Vila Franca de Xira, Portugal.
authors.forename: Alexandre
authors.initials: A
authors.lastname: Amaral-Silva
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D004185:Disability Evaluation; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D020127:Recovery of Function; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D020521:Stroke / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality / Q000503:physiopathology; D015912:Thrombolytic Therapy / Q000009:adverse effects / Q000401:mortality; D013997:Time Factors; D061665:Time-to-Treatment; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D005343:Fibrinolytic Agents
keywords: Stroke; elderly; over 80 years; thrombolysis