Thrombolysis in patients older than 80 years with acute ischaemic stroke: Canadian Alteplase for Stroke Effectiveness Study

Journal of Neurology, Neurosurgery, and Psychiatry
P N SylajaCanadian Alteplase for Stroke Effectiveness Study (CASES) Investigators

Abstract

The benefit of intravenous tissue plasminogen activator (tPA) given within 3 h of acute ischaemic stroke to patients over 80 years of age is uncertain. To examine the clinical characteristics and complications and the predictors of outcome after intravenous tPA treatment in patients aged > or = 80 years. Data (n = 1135) prospectively collected from the Canadian Alteplase for Stroke Effectiveness Study were reviewed and patients aged > or = 80 years (n = 270) treated with intravenous tPA for acute ischaemic stroke were compared with those aged <80 years (n = 865). The risk of symptomatic intracerebral haemorrhage did not differ between patients aged > or = 80 years and <80 years (4.4% (95% CI 2.3 to 7.6) v 4.6% (95% CI 3.3 to 6.2), p = 1.0). Favourable outcome, defined as a modified Rankin Score of 0-1 at 90 days, was seen in 26% of patients aged > or = 80 years and in 40% of those <80 (p<0.001). The following baseline characteristics were found to be more common in those aged > or = 80 years than in those aged <80 years: atrial fibrillation (37% v 18%; p<0.001); congestive heart failure (11% v 6%; p = 0.004); hypertension (59% v 48%; p = 0.002); and severity of stroke with a median National Institutes of Health Stroke Scale (NI...Continue Reading

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