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Related Experiment Videos

Thrombolysis for stroke in the elderly.

Bijan Vatankhah1, Michael S Dittmar, Nando P Fehm

  • 1Department of Neurology, University of Regensburg, Universitaetsstrasse 84, D-93053 Regensburg, Germany. Bijan.Vatankhah@medbo.de

Journal of Thrombosis and Thrombolysis
|September 1, 2005
PubMed
Summary

Elderly patients over 75, including those over 80, with acute ischemic stroke can benefit from intravenous recombinant tissue plasminogen activator (rt-PA) treatment. This therapy shows good in-hospital outcomes and high survival rates with manageable bleeding risks in this population.

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Area of Science:

  • Neurology
  • Cardiovascular Medicine
  • Geriatrics

Background:

  • Systemic thrombolysis with intravenous recombinant tissue plasminogen activator (rt-PA) is approved for acute ischemic stroke, with age restrictions often limiting its use in elderly patients due to increased bleeding risk.
  • Previous rt-PA trials had limited data on patients over 80 years old, necessitating further investigation into treatment efficacy and safety in this demographic.

Purpose of the Study:

  • To evaluate the clinical outcomes and safety of intravenous rt-PA in patients aged 75 years and older with middle cerebral artery ischemia.
  • To assess the efficacy and risks of rt-PA in very elderly stroke patients (over 80 years old) compared to those aged 76-80.

Main Methods:

  • Retrospective analysis of a stroke database to identify patients aged 75 and older treated with intravenous rt-PA for middle cerebral artery ischemia between February 1999 and July 2004.

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  • Assessment of clinical course, neurological status (NIH Stroke Scale), and mortality at 3 and 6 months post-treatment.
  • Analysis of parenchymal and extracerebral bleeding complications.

    • Main Results:

    • Twenty-nine patients (mean age 80.8 years, 16 over 80) received rt-PA, representing 21.2% of all thrombolyzed patients.
    • Good in-hospital recovery (NIH-SS improvement ≥4 points) was observed in 13/29 patients by day 5.
    • Overall 6-month mortality was 20.7%, with no significant difference in outcomes between patients aged 76-80 and those over 80.
    • Cerebral bleeding occurred in 10.3% (non-symptomatic) and 3.4% (symptomatic) of patients; one death was attributed to space-occupying cerebral hemorrhage.

    Conclusions:

    • Intravenous rt-PA treatment in patients over 75 years old, including those over 80, resulted in good in-hospital neurological outcomes in nearly 45% and a 6-month survival rate of almost 80%.
    • The study suggests that elderly patients over 75, even those over 80, in good medical condition may benefit from systemic rt-PA therapy.
    • Further prospective studies are required to identify specific subgroups of elderly patients most likely to benefit from systemic thrombolysis.