Related Experiment Video
Updated: Jun 15, 2026
05:52
Prehospital Thrombolysis: A Manual from Berlin
Published on: November 26, 2013
Intravenous tissue plasminogen activator and stroke in the elderly
W T Longstreth1, Ronit Katz, David L Tirschwell
1Department of Neurology, University of Washington, Seattle, 98195, USA. wl@u.washington.edu
The American Journal of Emergency Medicine
|March 13, 2010
Summary
Intravenous tissue plasminogen activator (IV tPA) did not significantly improve outcomes for stroke patients over 80 in the NINDS trial and increased hemorrhage risk. Further research is needed to clarify its risk-benefit profile in this age group.
Area of Science:
- Neurology
- Cardiovascular Medicine
- Geriatrics
Background:
- The efficacy and safety of intravenous tissue plasminogen activator (IV tPA) for acute ischemic stroke in elderly patients, particularly those over 80, remain uncertain since its 1995 approval.
- The National Institute of Neurological Disorders and Stroke (NINDS) trial provided initial data, but specific outcomes for the oldest demographic were not fully elucidated.
Purpose of the Study:
- To analyze the outcomes of IV tPA treatment in patients over 80 years old using data from the NINDS trial.
- To estimate the utilization and hospital outcomes of IV tPA in older adults post-1995, using the Cardiovascular Health Study cohort.
Main Methods:
- Retrospective analysis of 44 randomized subjects over 80 from the NINDS IV tPA trial.
- Longitudinal cohort study analysis of 5888 elderly participants from the Cardiovascular Health Study (CHS) from 1989 onwards, focusing on stroke cases between 1995-2002.
Main Results:
- In the NINDS trial, IV tPA did not significantly improve 3-month functional outcomes for patients over 80. Four of 25 treated patients experienced symptomatic intracranial hemorrhage.
- Older patients (over 80) were 2.87 times more likely to have symptomatic intracranial hemorrhage within 36 hours of IV tPA compared to younger patients.
- In the CHS cohort, only 3.1% of elderly ischemic stroke patients received IV tPA between 1995-2002; two of seven treated patients had symptomatic intracranial hemorrhage, and two had good outcomes.
Conclusions:
- The study indicates a potential increased risk of symptomatic intracranial hemorrhage with IV tPA use in patients over 80.
- The risk-benefit profile of IV tPA in ischemic stroke patients over 80 requires further clarification due to uncertain benefits and increased risks.
Related Concept Videos
01:29Venous Thrombosis III: Interprofessional Care
Venous thrombosis requires effective prevention and treatment strategies to improve patient outcomes and reduce potential complications.Prevention StrategiesHealthcare providers must prioritize preventing venous thromboembolism (VTE) for all adult patients upon admission. Interventions depend on bleeding and thrombosis risk, medical history, current medications, diagnoses, planned procedures, and patient preferences. Patients on bed rest should change positions every two hours and, if not...
01:29Pulmonary Embolism II: Diagnostic Studies and Interprofessional Care
Diagnosing Pulmonary EmbolismDiagnosing pulmonary embolism (PE) involves clinical assessment and advanced imaging tests. The preferred diagnostic tool is the spiral (helical) CT scan or CT angiography (CTA), which uses intravenous contrast media to visualize the pulmonary vasculature and identify emboli.A ventilation-perfusion (V/Q) scan is an alternative for patients unable to receive contrast media. This scan includes both perfusion and ventilation scanning. Perfusion scanning involves...
01:15Ischemic Stroke ll: Pathophysiology
An ischemic stroke occurs when a cerebral blood vessel becomes obstructed, most often by a thrombus or embolus, interrupting the delivery of oxygen and glucose to brain tissue. Because neurons rely on continuous aerobic metabolism, energy failure begins within minutes of reduced perfusion. The region receiving the least blood flow becomes the infarct core, an area of irreversible cellular death. Surrounding this core lies the penumbra, a zone of hypoperfused but still viable tissue that is...
01:18Anticoagulant Drugs: Vitamin K Antagonists and Direct Oral Anticoagulants
Oral anticoagulants are vital tools in preventing and treating blood clotting disorders. This diverse class of medications can be categorized as vitamin K antagonists, exemplified by warfarin, and direct thrombin inhibitors (DTIs), such as dabigatran, as well as factor Xa inhibitors, including rivaroxaban.
Warfarin, a prominent vitamin K antagonist family member, exerts its effect by inhibiting the enzyme VKORC1 (vitamin K epoxide reductase complex 1). By hindering this enzyme, warfarin...
Warfarin, a prominent vitamin K antagonist family member, exerts its effect by inhibiting the enzyme VKORC1 (vitamin K epoxide reductase complex 1). By hindering this enzyme, warfarin...
01:15Ischemic Stroke l: Introduction
Ischemic stroke is an acute cerebrovascular condition in which blood flow to a brain region is suddenly interrupted, leading to tissue infarction. Neurons depend on continuous oxygen and glucose supply, so even brief reductions in perfusion cause energy failure, ionic imbalance, and irreversible injury. Ischemic strokes are classified into thrombotic and embolic types based on their underlying mechanisms.Thrombotic MechanismsThrombotic stroke develops when a clot forms within a cerebral artery.
01:30Venous Thrombosis IV: Nursing Management
Nursing management begins with a thorough assessment of the patient's health history. Key factors include trauma to veins, peripherally inserted central catheters, varicose veins, recent pregnancy or childbirth, surgery, bacteremia, prolonged bed rest, atrial fibrillation, COPD, heart failure, cancer, coagulation disorders, myocardial infarction, spinal cord injury, stroke, prolonged travel, recent bone fractures, and dehydration. Review medication intake, particularly oral contraceptives,...