Thrombolysis for acute stroke with special emphasis on the very old: experience from a single Dutch centre

The aim of this study was to describe the clinical experience in 184 consecutive stroke patients first-ever treated with recombinant tissue plasminogen activator (rt-PA) at a single Dutch centre, with special emphasis on results among the very old. Outcome parameters were the modified Rankin scale (mRs) at 3 months and symptomatic intracranial haemorrhage (SICH). Outcome was related to age. A total of 184 patients were treated of whom 45 were 80 years of age or older (24%). Sixty two (45%) of 139 patients < 80 years of age and 12 (27%) of 45 patients > or = 80 years of age had a favourable outcome defined as an mRs score of 0 or 1 (OR 2.21; 95% CI: 1.06 to 4.46). There was a good outcome (mRs score < or = 2) in 88 (63%) and 16 (36%) patients, respectively (OR 3.13; 95% CI: 1.55 to 6.30). SICH was observed in four of 139 (2.9%) patients < 80 years of age and in five of 45 (11.1%) patients > or = 80 years of age (OR 4.22; 95% CI: 1.08 to 16.46). The results of this study underline the uncertainty regarding the risk/benefit ratio of rt-PA treatment in acute stroke in patients over 80 years of age.