Intravenous Tissue Plasminogen Activator for Acute Ischemic Stroke in Patients Aged 80 Years and Older

Author:

Tanne David1,Gorman Mark J.1,Bates Vernice E.1,Kasner Scott E.1,Scott Phillip1,Verro Piero1,Binder Jeffrey R.1,Dayno Jeffrey M.1,Schultz Lonni R.1,Levine Steven R.1

Affiliation:

1. From the Departments of Neurology (D.T., M.J.G., S.R.L.) and Biostatistics and Research Epidemiology (L.R.S.), Henry Ford Health Science Center, Detroit, Mich; Department of Neurology, Dent Neurological Institute, Buffalo, NY (V.E.B.); Department of Neurology, University of Pennsylvania Medical Center, Philadelphia (S.E.K.); Department of Emergency Medicine, University of Michigan Medical Center, Ann Arbor (P.S.); Department of Neurology, Seton-Hall University, East Orange, NJ (P.V.); Department of...

Abstract

Background and Purpose —Intravenous tissue plasminogen activator (tPA) administered within 3 hours of symptom onset is the first available effective therapy for acute ischemic stroke (AIS). Few data exist, however, on its use in very elderly patients. We examined the characteristics, complications, and short-term outcome of AIS patients aged ≥80 years treated with tPA. Methods —Patients aged ≥80 years (n=30) were compared with counterparts aged <80 years (n=159) included in the tPA Stroke Survey, a US retrospective survey of 189 consecutive AIS patients treated with intravenous tPA at 13 hospitals. Results —Risk of intracerebral hemorrhage (fatal, symptomatic, and total) was 3%, 3%, and 7% in the elderly age group and 2%, 6%, and 9%, respectively, in their younger counterparts ( P =NS for all comparisons). Likelihood of favorable outcome, defined as modified Rankin score 0 to 1, National Institutes of Health Stroke Scale score ≤5, or marked improvement by hospital discharge, was comparable between groups (37%, 54%, and 43% versus 30%, 54%, and 43%, respectively; P =NS for all comparisons). Elderly patients were more likely to be treated by stroke specialists (87% versus 60%; P =0.005) and less likely to have an identified protocol deviation (13% versus 33%; P =0.03). Elderly patients were discharged more often to nursing care facilities (17% versus 5%; P =0.003). In logistic regression models there were no differences in odds ratio for favorable or poor outcome, other than tendency for higher in-hospital mortality in elderly patients (odds ratio, 2.8; 95% CI, 0.81 to 9.62; P =0.10). Conclusions —Among AIS patients treated with intravenous tPA, age-related differences in characteristics and disposition were identified. No evidence for withholding tPA treatment for AIS in appropriately selected patients aged ≥80 years was identified.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Advanced and Specialized Nursing,Cardiology and Cardiovascular Medicine,Neurology (clinical)

Reference37 articles.

1. Day JC. Population Projections of the United States by Age Sex Race and Hispanic Origin: 1995 to 2050 . Washington DC: US Bureau of the Census US Government Printing Office; 1996. Current Population Reports publication P25-1130.

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