TPA for ischemic stroke in patients ≥80 years

Area of Science:

• Neurology
• Geriatrics
• Emergency Medicine

Background:

• Randomized controlled trials (RCTs) for tissue plasminogen activator (tPA) in acute ischemic stroke (AIS) typically exclude patients over 80 years old.
• Despite exclusion from trials, many centers administer tPA to elderly patients.
• The impact of advanced age on tPA treatment outcomes in AIS remains an important clinical question.

Purpose of the Study:

• To investigate whether age ≥80 years is an independent predictor of outcomes following tPA treatment for AIS.
• To analyze the association between advanced age and specific adverse events (symptomatic intracerebral hemorrhage, death) and functional recovery.

Main Methods:

• A retrospective study included 77 patients aged ≥80 years and 83 patients aged <80 years who received tPA within 4.5 hours of AIS onset.
• Multiple logistic regression analyses were performed to assess the relationship between age (≥80 vs. <80 years) and outcomes.
• Outcomes evaluated included symptomatic intracerebral hemorrhage (sICH), mortality at 3 months, and good functional outcome (modified Rankin Scale 0-1).

Main Results:

• Age ≥80 years was significantly associated with an increased risk of sICH (OR, 18.2) and death (OR, 3.3) within 3 months.
• Advanced age did not predict functional outcome at 3 months (mRS 0-1).
• Other predictors of death included longer onset-to-treatment time (OTT), higher NIH Stroke Scale (NIHSS) score, and prior stroke. Shorter OTT and lower NIHSS predicted good functional outcome.

Conclusions:

• Advanced age (≥80 years) may be an independent risk factor for sICH and mortality in the initial 3 months post-tPA for AIS.
• Age does not appear to influence the likelihood of achieving a good functional outcome.
• Treatment with tPA in patients over 80 years is suggested, with caution advised for those with longer onset-to-treatment times.