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[Systemic thrombolysis with plasminogen activator in chronic stroke patients]
R von Kummer1, E Bluhmki, P Ringleb
1Abteilung Neuroradiologie, Universitätsklinikum Carl Gustav Carus, TU Dresden.
Der Nervenarzt
|October 3, 1998
Summary
Intravenous thrombolysis with recombinant tissue plasminogen activator (rt-PA) significantly improved outcomes only in younger stroke patients. Older patients experienced worse clinical courses and similar hemorrhage risks, suggesting a less favorable risk-benefit ratio for rt-PA in those over 70.
Area of Science:
- Neurology
- Clinical Medicine
- Pharmacology
Background:
- Stroke treatment efficacy can vary significantly with patient age.
- Intravenous thrombolysis is a critical treatment for acute ischemic stroke.
Purpose of the Study:
- To analyze the efficacy and safety of intravenous recombinant tissue plasminogen activator (rt-PA) in different age groups following acute ischemic stroke.
- To compare treatment outcomes and risks between younger (<70 years) and older (≥70 years) stroke patients.
Main Methods:
- Retrospective analysis of 615 patients from the ECASS I trial.
- Stratification of patients into two age groups: ≤70 years and >70 years.
- Comparison of clinical outcomes (Barthel Index, disability status) and mortality rates between rt-PA treated and placebo groups within each age stratum.
Main Results:
- Older patients (n=248) had a more severe clinical course and higher mortality (24% vs. 11%) compared to younger patients (n=367) in the placebo group.
- rt-PA significantly increased the proportion of undisabled patients at 3 months only in the younger age group.
- The risk of brain parenchymal hemorrhage increased by a factor of 4.6-4.7 in both age groups with rt-PA treatment.
Conclusions:
- Systemic thrombolysis with rt-PA is less effective in achieving an undisabled state in elderly stroke patients.
- The risk-benefit ratio of rt-PA may be less favorable in patients over 70 years due to increased risks and potentially lower efficacy.