title: Use and Outcomes of Intravenous Thrombolysis for Acute Ischemic Stroke in Patients ≥90 Years of Age.
abstract: Intravenous tissue-type plasminogen activator (tPA) is a proven treatment for acute ischemic stroke, but there has been limited evaluation among patients aged ≥90 years.
  
  
  
  We analyzed data from the Get With The Guidelines-Stroke national quality improvement registry from January 2009 to April 2013. Frequency, determinants, and outcomes of tPA use were compared among patients aged ≥90 and 3 younger age groups (18-64, 65-79, and 80-89 years).
  
  
  
  Among 35 708 patients from 1178 sites who arrived within 2 hours of time last known well and received tPA, 2585 (7.2%) were ≥90 years. Compared with younger patients, the rate of tPA use among patients without a documented contraindication was lower among patients aged ≥90 years (67.4% versus 84.1% in 18-89-year olds; P<0.0001). Discharge outcomes among individuals aged ≥90 years included discharge to home or acute rehabilitation in 31.4%, independent ambulation at discharge in 13.4%, symptomatic hemorrhage in 6.1%, and in-hospital mortality or hospice discharge in 36.4%. On multivariable analysis, good functional outcomes generally occurred less often and mortality more often among patients aged ≥90 years. The risk of symptomatic hemorrhage was increased compared with patients <65 years but was not significantly different than the risk in 66- to 89-year olds.
  
  
  
  The use of intravenous tPA among those aged ≥90 years is lower than in younger patients. When fibrinolytic therapy is used, the risk of symptomatic hemorrhage is not higher than in 66- to 89-year olds; however, mortality is higher and functional outcomes are lower.
authors: From the Department of Neurology, Hofstra Northwell School of Medicine, Hempstead, NY (R.A., E.S., J.M.K., R.B.L); Outcomes Research and Assessment Group (M.C.), Division of Cardiology, Department of Medicine (E.D.P.), and Department of Neurology (Y.X.), Duke Clinical Research Institute, Durham, NC; Department of Neurology and Comprehensive Stroke Center, David Geffen School of Medicine (J.L.S.) and Division of Cardiology (G.C.F.), University of California, Los Angeles; Brigham and Women's Heart and Vascular Center and Harvard Medical School, Boston, MA (D.L.B.); Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Alberta, Canada (E.E.S.); and Stroke Service, Department of Neurology, Massachusetts General Hospital, Boston (L.H.S.).
authors: Rohan
authors: R
authors: Arora
authors: From the Department of Neurology, Hofstra Northwell School of Medicine, Hempstead, NY (R.A., E.S., J.M.K., R.B.L); Outcomes Research and Assessment Group (M.C.), Division of Cardiology, Department of Medicine (E.D.P.), and Department of Neurology (Y.X.), Duke Clinical Research Institute, Durham, NC; Department of Neurology and Comprehensive Stroke Center, David Geffen School of Medicine (J.L.S.) and Division of Cardiology (G.C.F.), University of California, Los Angeles; Brigham and Women's Heart and Vascular Center and Harvard Medical School, Boston, MA (D.L.B.); Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Alberta, Canada (E.E.S.); and Stroke Service, Department of Neurology, Massachusetts General Hospital, Boston (L.H.S.).
authors: Elliott
authors: E
authors: Salamon
authors: From the Department of Neurology, Hofstra Northwell School of Medicine, Hempstead, NY (R.A., E.S., J.M.K., R.B.L); Outcomes Research and Assessment Group (M.C.), Division of Cardiology, Department of Medicine (E.D.P.), and Department of Neurology (Y.X.), Duke Clinical Research Institute, Durham, NC; Department of Neurology and Comprehensive Stroke Center, David Geffen School of Medicine (J.L.S.) and Division of Cardiology (G.C.F.), University of California, Los Angeles; Brigham and Women's Heart and Vascular Center and Harvard Medical School, Boston, MA (D.L.B.); Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Alberta, Canada (E.E.S.); and Stroke Service, Department of Neurology, Massachusetts General Hospital, Boston (L.H.S.).
authors: Jeffrey M
authors: JM
authors: Katz
authors: From the Department of Neurology, Hofstra Northwell School of Medicine, Hempstead, NY (R.A., E.S., J.M.K., R.B.L); Outcomes Research and Assessment Group (M.C.), Division of Cardiology, Department of Medicine (E.D.P.), and Department of Neurology (Y.X.), Duke Clinical Research Institute, Durham, NC; Department of Neurology and Comprehensive Stroke Center, David Geffen School of Medicine (J.L.S.) and Division of Cardiology (G.C.F.), University of California, Los Angeles; Brigham and Women's Heart and Vascular Center and Harvard Medical School, Boston, MA (D.L.B.); Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Alberta, Canada (E.E.S.); and Stroke Service, Department of Neurology, Massachusetts General Hospital, Boston (L.H.S.).
authors: Margueritte
authors: M
authors: Cox
authors: From the Department of Neurology, Hofstra Northwell School of Medicine, Hempstead, NY (R.A., E.S., J.M.K., R.B.L); Outcomes Research and Assessment Group (M.C.), Division of Cardiology, Department of Medicine (E.D.P.), and Department of Neurology (Y.X.), Duke Clinical Research Institute, Durham, NC; Department of Neurology and Comprehensive Stroke Center, David Geffen School of Medicine (J.L.S.) and Division of Cardiology (G.C.F.), University of California, Los Angeles; Brigham and Women's Heart and Vascular Center and Harvard Medical School, Boston, MA (D.L.B.); Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Alberta, Canada (E.E.S.); and Stroke Service, Department of Neurology, Massachusetts General Hospital, Boston (L.H.S.). jsaver@mednet.ucla.edu.
authors: Jeffrey L
authors: JL
authors: Saver
authors: From the Department of Neurology, Hofstra Northwell School of Medicine, Hempstead, NY (R.A., E.S., J.M.K., R.B.L); Outcomes Research and Assessment Group (M.C.), Division of Cardiology, Department of Medicine (E.D.P.), and Department of Neurology (Y.X.), Duke Clinical Research Institute, Durham, NC; Department of Neurology and Comprehensive Stroke Center, David Geffen School of Medicine (J.L.S.) and Division of Cardiology (G.C.F.), University of California, Los Angeles; Brigham and Women's Heart and Vascular Center and Harvard Medical School, Boston, MA (D.L.B.); Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Alberta, Canada (E.E.S.); and Stroke Service, Department of Neurology, Massachusetts General Hospital, Boston (L.H.S.).
authors: Deepak L
authors: DL
authors: Bhatt
authors: From the Department of Neurology, Hofstra Northwell School of Medicine, Hempstead, NY (R.A., E.S., J.M.K., R.B.L); Outcomes Research and Assessment Group (M.C.), Division of Cardiology, Department of Medicine (E.D.P.), and Department of Neurology (Y.X.), Duke Clinical Research Institute, Durham, NC; Department of Neurology and Comprehensive Stroke Center, David Geffen School of Medicine (J.L.S.) and Division of Cardiology (G.C.F.), University of California, Los Angeles; Brigham and Women's Heart and Vascular Center and Harvard Medical School, Boston, MA (D.L.B.); Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Alberta, Canada (E.E.S.); and Stroke Service, Department of Neurology, Massachusetts General Hospital, Boston (L.H.S.).
authors: Gregg C
authors: GC
authors: Fonarow
authors: From the Department of Neurology, Hofstra Northwell School of Medicine, Hempstead, NY (R.A., E.S., J.M.K., R.B.L); Outcomes Research and Assessment Group (M.C.), Division of Cardiology, Department of Medicine (E.D.P.), and Department of Neurology (Y.X.), Duke Clinical Research Institute, Durham, NC; Department of Neurology and Comprehensive Stroke Center, David Geffen School of Medicine (J.L.S.) and Division of Cardiology (G.C.F.), University of California, Los Angeles; Brigham and Women's Heart and Vascular Center and Harvard Medical School, Boston, MA (D.L.B.); Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Alberta, Canada (E.E.S.); and Stroke Service, Department of Neurology, Massachusetts General Hospital, Boston (L.H.S.).
authors: Eric D
authors: ED
authors: Peterson
authors: From the Department of Neurology, Hofstra Northwell School of Medicine, Hempstead, NY (R.A., E.S., J.M.K., R.B.L); Outcomes Research and Assessment Group (M.C.), Division of Cardiology, Department of Medicine (E.D.P.), and Department of Neurology (Y.X.), Duke Clinical Research Institute, Durham, NC; Department of Neurology and Comprehensive Stroke Center, David Geffen School of Medicine (J.L.S.) and Division of Cardiology (G.C.F.), University of California, Los Angeles; Brigham and Women's Heart and Vascular Center and Harvard Medical School, Boston, MA (D.L.B.); Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Alberta, Canada (E.E.S.); and Stroke Service, Department of Neurology, Massachusetts General Hospital, Boston (L.H.S.).
authors: Eric E
authors: EE
authors: Smith
authors: From the Department of Neurology, Hofstra Northwell School of Medicine, Hempstead, NY (R.A., E.S., J.M.K., R.B.L); Outcomes Research and Assessment Group (M.C.), Division of Cardiology, Department of Medicine (E.D.P.), and Department of Neurology (Y.X.), Duke Clinical Research Institute, Durham, NC; Department of Neurology and Comprehensive Stroke Center, David Geffen School of Medicine (J.L.S.) and Division of Cardiology (G.C.F.), University of California, Los Angeles; Brigham and Women's Heart and Vascular Center and Harvard Medical School, Boston, MA (D.L.B.); Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Alberta, Canada (E.E.S.); and Stroke Service, Department of Neurology, Massachusetts General Hospital, Boston (L.H.S.).
authors: Lee H
authors: LH
authors: Schwamm
authors: From the Department of Neurology, Hofstra Northwell School of Medicine, Hempstead, NY (R.A., E.S., J.M.K., R.B.L); Outcomes Research and Assessment Group (M.C.), Division of Cardiology, Department of Medicine (E.D.P.), and Department of Neurology (Y.X.), Duke Clinical Research Institute, Durham, NC; Department of Neurology and Comprehensive Stroke Center, David Geffen School of Medicine (J.L.S.) and Division of Cardiology (G.C.F.), University of California, Los Angeles; Brigham and Women's Heart and Vascular Center and Harvard Medical School, Boston, MA (D.L.B.); Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Alberta, Canada (E.E.S.); and Stroke Service, Department of Neurology, Massachusetts General Hospital, Boston (L.H.S.).
authors: Ying
authors: Y
authors: Xian
authors: From the Department of Neurology, Hofstra Northwell School of Medicine, Hempstead, NY (R.A., E.S., J.M.K., R.B.L); Outcomes Research and Assessment Group (M.C.), Division of Cardiology, Department of Medicine (E.D.P.), and Department of Neurology (Y.X.), Duke Clinical Research Institute, Durham, NC; Department of Neurology and Comprehensive Stroke Center, David Geffen School of Medicine (J.L.S.) and Division of Cardiology (G.C.F.), University of California, Los Angeles; Brigham and Women's Heart and Vascular Center and Harvard Medical School, Boston, MA (D.L.B.); Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Alberta, Canada (E.E.S.); and Stroke Service, Department of Neurology, Massachusetts General Hospital, Boston (L.H.S.).
authors: Richard B
authors: RB
authors: Libman
mesh_terms: D061605:Administration, Intravenous; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000188:drug therapy* / Q000401:mortality; D005260:Female; D005343:Fibrinolytic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D017052:Hospital Mortality; D006801:Humans; D020300:Intracranial Hemorrhages / Q000139:chemically induced / Q000401:mortality; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians'; D011379:Prognosis; D012042:Registries; D012189:Retrospective Studies; D020521:Stroke / Q000188:drug therapy* / Q000401:mortality; D015912:Thrombolytic Therapy / Q000009:adverse effects*; D010959:Tissue Plasminogen Activator / Q000009:adverse effects / Q000627:therapeutic use*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator
keywords: hospices; hospital mortality; stroke; thrombolytic therapy; tissue-type plasminogen activator