TPA for ischemic stroke in patients ≥80 years

• Published in: Acta neurologica Scandinavica Vol. 127; no. 5; pp. 309 - 315
• Main Authors: Henriksen, E. H., Ljøstad, U., Tveiten, A., Næss, H., Thomassen, L., Mygland, Å.
• Format: Journal Article
• Language: English
• Published: Denmark Blackwell Publishing Ltd 01.05.2013; Hindawi Limited
• Subjects: Acute Disease; Age Factors; Age of Onset; Aged, 80 and over; Brain Damage, Chronic - epidemiology; Brain Damage, Chronic - etiology; Brain Ischemia - drug therapy; Brain Ischemia - epidemiology; Cerebral Hemorrhage - chemically induced; Comorbidity; elderly; Emergencies; Female; Fibrinolytic Agents - adverse effects; Fibrinolytic Agents - therapeutic use; Follow-Up Studies; Humans; intracerebral hemorrhage; ischemic stroke; Male; Medical research; Norway - epidemiology; Prognosis; Prospective Studies; Recovery of Function; Risk Factors; Severity of Illness Index; Stroke; thrombolysis; Thrombolytic Therapy - adverse effects; Time Factors; Tissue Plasminogen Activator - adverse effects; Tissue Plasminogen Activator - therapeutic use; Treatment Outcome; Norway
• ISSN: 0001-6314; 1600-0404
• DOI: 10.1111/ane.12008

Objective Although patients >80 years were excluded in RCTs for tPA treatment of acute ischemic stroke (AIS), many centers treat old patients. We wanted to examine whether age ≥80 years is an independent predictor of outcome after tPA. Materials We included 77 consecutive patients ≥80 years and 83 patients <80 years treated with tPA within 4.5 h after onset of AIS. Baseline variables were analyzed by multiple stepwise logistic regression analyses against three outcomes: symptomatic intracerebral hemorrhage (sICH), death and good functional outcome (mRS, 0–1) at 3‐month follow‐up. Results Age ≥80 years was associated with increased risk of sICH (OR, 18.2 [95% CI, 1.0–324.1], P = 0.048), and death (OR, 3.3 [95% CI, 1.2–9.1], P = 0.018), but not with functional outcome at 3 months. Other factors associated with death were longer onset to treatment time (OTT) (OR, 1.007/min increase [95% CI, 1.00–1.015], P = 0.047), higher NIHSS (OR, 1.12 per point increase [95% CI, 1.04–1.19], P = 0.001), and previous stroke (OR, 4.0 [95% CI, 1.2–13.7], P = 0.03). Predictors of good functional outcome were shorter OTT (OR, 0.99 [95% CI, 0.98–1.00], P = 0.02) and lower NIHSS (OR, 0.80 [95% CI, 0.74–0.87] P ≤ 0.001). Conclusion Age ≥80 years might be an independent risk factor for sICH and death the first 3 months after treatment with tPA for AIS, but does not influence the chance of a good functional outcome. We suggest to treat patients over 80 years with tPA, but be cautious if the time from onset (OTT) is long.