Intravenous Thrombolysis in Patients With Ischemic Stroke Aged ≥90 Years: A Cohort Study From the TRISP Collaboration-Reference-Cited by-同舟云学术

Intravenous Thrombolysis in Patients With Ischemic Stroke Aged ≥90 Years: A Cohort Study From the TRISP Collaboration

Published:2022-12 Issue:12 Volume:53 Page:3557-3563
ISSN:0039-2499
Container-title:Stroke
language:en
Short-container-title:Stroke

Author:

Altersberger Valerian L.¹^ORCID,Rusche Norman¹²^ORCID,Martinez-Majander Nicolas³^ORCID,Hametner Christian⁴^ORCID,Scheitz Jan F.⁵^ORCID,Henon Hilde⁶^ORCID,Dell’Acqua Maria Luisa⁷^ORCID,Strambo Davide⁸^ORCID,Stolp Jeffrey⁹^ORCID,Heldner Mirjam R.¹⁰^ORCID,Grisendi Ilaria¹¹^ORCID,Jovanovic Dejana R.¹²^ORCID,Bejot Yannick¹³^ORCID,Pezzini Alessandro¹⁴,Leker Ronen R.¹⁵^ORCID,Kägi Georg¹⁰¹⁶^ORCID,Wegener Susanne¹⁷^ORCID,Cereda Carlo W.¹⁸^ORCID,Lindgren Erik¹⁹^ORCID,Ntaios George²⁰^ORCID,Piot Ines¹^ORCID,Polymeris Alexandros A.¹^ORCID,Lyrer Philippe A.¹^ORCID,Räty Silja³^ORCID,Sibolt Gerli³,Tiainen Marjaana³^ORCID,Heyse Miriam⁴,Erdur Hebun⁵^ORCID,Kaaouana Olfa⁶,Padjen Visnja¹²^ORCID,Zedde Marialuisa¹¹^ORCID,Arnold Marcel¹⁰,Nederkoorn Paul J.⁹,Michel Patrik⁸,Bigliardi Guido⁷^ORCID,Zini Andrea²¹^ORCID,Cordonnier Charlotte⁶^ORCID,Nolte Christian H.⁵,Ringleb Peter A.⁴^ORCID,Curtze Sami³^ORCID,Engelter Stefan T.¹²^ORCID,Gensicke Henrik¹²^ORCID,

Affiliation:

1. Stroke Center and Department of Neurology, University Hospital Basel and University of Basel, Switzerland (V.L.A., N.R., I.P., A.A.P., P.A.L., S.T.E., H.G.).

2. Neurology and Neurorehabilitation, University Department of Geriatric Medicine FELIX PLATTER, University of Basel, Switzerland (N.R., S.T.E., H.G.).

3. Neurology, University of Helsinki and Helsinki University Hospital, Finland (N.M.-M., S.R., G.S., M.T., S.C.).

4. Department of Neurology, University Hospital Heidelberg, Germany C.H., M.H., P.A.R.).

5. Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Klinik und Hochschulambulanz für Neurologie, Center for Stroke Research Berlin (CSB), Charité – Universitätsmedizin Berlin, Berlin Institute of Health at Charité – Universitätsmedizin Berlin, Germany (J.F.S., H.E., C.H.N.).

6. Univ. Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, F-59000 Lille, France (H.H., O.K., C.C.).

7. Neurology - Stroke Unit, Department of Neuroscience, Ospedale Civile di Baggiovara, Modena University Hospital, Italy (M.L.D.A., G.B.).

8. Stroke Center, Neurology Service, Lausanne University Hospital and University of Lausanne, Switzerland (D.S., P.M.).

9. Amsterdam UMC location University of Amsterdam, Department of Neurology, the Netherlands (J.S., P.J.N.).

10. Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Switzerland (M.R.H., G.K., M.A.).

11. Neurology Unit-Stroke Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Italy (I.G., M.Z.).

12. University of Belgrade, Faculty of Medicine, Neurology Clinic, University Clinical Centre of Serbia (D.R.J., V.P.).

13. Department of Neurology, University Hospital Dijon, France (Y.B.).

14. Department of Clinical and Experimental Sciences, Neurology Clinic, University of Brescia, Italy (A.P.).

15. Department of Neurology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel (R.R.L.).

16. Department of Neurology, Kantonsspital St. Gallen, Switzerland (G.K.).

17. Department of Neurology, University Hospital Zurich and University of Zurich, Switzerland (S.W.).

18. Stroke Center EOC, Neurology, Neurocenter of Southern Switzerland, EOC, Lugano, Switzerland (C.W.C.).

19. Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg; Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden (E.L.).

20. Department of Internal Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece (G.N.).

21. IRCCS Istituto delle Scienze Neurologiche di Bologna, Department of Neurology and Stroke Center, Maggiore Hospital, Bologna, Italy (A.Z.).

Abstract

Background: The probability to receive intravenous thrombolysis (IVT) for treatment of acute ischemic stroke declines with increasing age and is consequently the lowest in very elderly patients. Safety concerns likely influence individual IVT treatment decisions. Using data from a large IVT registry, we aimed to provide more evidence on safety of IVT in the very elderly. Methods: In this prospective multicenter study from the TRISP (Thrombolysis in Ischemic Stroke Patients) registry, we compared patients ≥90 years with those <90 years using symptomatic intracranial hemorrhage (ECASS [European Cooperative Acute Stroke Study]-II criteria), death, and poor functional outcome in survivors (modified Rankin Scale score 3–5 for patients with prestroke modified Rankin Scale score ≤2 and modified Rankin Scale score 4–5 for patients prestroke modified Rankin Scale ≥3) at 3 months as outcomes. We calculated adjusted odds ratio with 95% CI using logistic regression models. Results: Of 16 974 eligible patients, 976 (5.7%) were ≥90 years. Patients ≥90 years had higher median National Institutes of Health Stroke Scale on admission (12 versus 8) and were more often dependent prior to the index stroke (prestroke modified Rankin Scale score of ≥3; 45.2% versus 7.4%). Occurrence of symptomatic intracranial hemorrhage (5.7% versus 4.4%, odds ratio adjusted 1.14 [0.83–1.57]) did not differ significantly between both groups. However, the probability of death (odds ratio adjusted 3.77 [3.14–4.53]) and poor functional outcome (odds ratio adjusted 2.63 [2.13–3.25]) was higher in patients aged ≥90 years. Results for the sample of centenarians (n=21) were similar. Conclusions: The probability of symptomatic intracranial hemorrhage after IVT in very elderly patients with stroke did not exceed that of their younger counterparts. The higher probability of death and poor functional outcome during follow-up in the very elderly seems not to be related to IVT treatment. Very high age itself should not be a reason to withhold IVT.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

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

Reference22 articles.

1. Intravenous thrombolysis for acute ischaemic stroke in the elderly: data from the Baden-Wuerttemberg stroke registry

2. Reasons and evolution of non-thrombolysis in acute ischaemic stroke

3. The benefits and harms of intravenous thrombolysis with recombinant tissue plasminogen activator within 6 h of acute ischaemic stroke (the third international stroke trial [IST-3]): a randomised controlled trial

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5. Effect of treatment delay, age, and stroke severity on the effects of intravenous thrombolysis with alteplase for acute ischaemic stroke: a meta-analysis of individual patient data from randomised trials

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