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Prehospital Thrombolysis: A Manual from Berlin
Published on: November 26, 2013
Thrombolytic therapy for acute stroke in the elderly: an emergent condition in developing countries
Sheila Cristina Ouriques Martins1, Maurício André Gheller Friedrich, Rosane Brondani
1Vascular Unit, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil; Vascular Care Unit, Hospital Mãe de Deus, Porto Alegre, Brazil. smartins@portoweb.com.br
Summary
Elderly patients (≥80 years) receiving recombinant tissue plasminogen activator (rtPA) for acute ischemic stroke showed comparable safety to younger patients, with a substantial favorable outcome rate. This supports rtPA use in selected older adults in developing nations.
Area of Science:
- Neurology
- Geriatrics
- Emergency Medicine
Background:
- Elderly individuals are a crucial demographic for evaluating novel stroke therapies, especially in resource-limited settings.
- Acute ischemic stroke treatment decisions require careful consideration of age-related factors and comorbidities.
Purpose of the Study:
- To assess the safety and efficacy of recombinant tissue plasminogen activator (rtPA) in elderly Brazilian patients (≥80 years) with acute ischemic stroke.
- To compare clinical, neuroimaging, and outcome data between elderly and nonelderly rtPA-treated stroke patients.
Main Methods:
- Retrospective analysis of 183 nonelderly (<80 years) and 55 elderly (≥80 years) patients treated with rtPA.
- Comparison of demographics, comorbidities, admission parameters (blood pressure, NIHSS, glucose), symptomatic intracranial hemorrhage rates, and 90-day functional outcomes (modified Rankin Scale).
Main Results:
- Elderly patients had higher rates of hypertension, atrial fibrillation, and prior stroke/TIA, along with higher NIHSS scores.
- Symptomatic intracranial hemorrhage rates were similar between groups (10.9% vs 6.6%, P=.28).
- A significant proportion of elderly patients achieved a favorable outcome (42% vs 58% in nonelderly, P=.04).
Conclusions:
- Intravenous rtPA is a viable treatment option for selected elderly patients with acute ischemic stroke in developing countries.
- While outcomes were slightly less favorable in the elderly, the safety profile was comparable, supporting its use in this population.
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