[Efficacy of tissue plasminogen activator in older patients]

To evaluate the efficacy, outcome, and side effects of tissue plasminogen activator for cerebral infarction in patients aged 75 years or older.

Subjects consisted of 30 patients who had been treated with tissue plasminogen activator between October, 2005 and March 2009, in Shimane University Hospital. We divided the patients into two groups: those less than 75 years old and those 75 years old and older, and evaluated the pattern of disease, therapeutic efficacy, side effects of bleeding, and factors affecting the modified Rankin Scale on discharge.

There was no significant difference between groups in the improvement level of NIH Stroke Scale (p=0.66), but modified Rankin Scale 2 or lower patients on discharge were significantly fewer (p=0.02). Multivariate analysis found that age was a factor in significant outcome deterioration (p=0.04, OR1.2). In the older patient group, there were significantly more unfavorable outcomes with anterior infarction. However, there was no significant difference between groups in outcome in patients with ASPECTS-DWI (Alberta Stroke Programme Early CT Score-Diffusion Weight Imaging) > or =8. There was no difference in the rate of hemorrhagic side effect between the two groups.

We can expect effects similar to those in patients younger than 75 years if the ischemic lesions of older patients are narrow when coming to the hospital.