TPA for ischemic stroke in patients ≥80 years
Article first published online: 18 SEP 2012
© 2012 John Wiley & Sons A/S
Acta Neurologica Scandinavica
Volume 127, Issue 5, pages 309–315, May 2013
How to Cite
TPA for ischemic stroke in patients ≥80 years. Acta Neurol Scand: DOI: 10.1111/ane.12008. © 2012 John Wiley & Sons A/S., , , , , .
- Issue published online: 13 APR 2013
- Article first published online: 18 SEP 2012
- Manuscript Accepted: 13 AUG 2012
- ischemic stroke;
- intracerebral hemorrhage;
Although patients >80 years were excluded in RCTs for tPA treatment of acute ischemic stroke (AIS), many centers treat old patients. We wanted to examine whether age ≥80 years is an independent predictor of outcome after tPA.
We included 77 consecutive patients ≥80 years and 83 patients <80 years treated with tPA within 4.5 h after onset of AIS. Baseline variables were analyzed by multiple stepwise logistic regression analyses against three outcomes: symptomatic intracerebral hemorrhage (sICH), death and good functional outcome (mRS, 0–1) at 3-month follow-up.
Age ≥80 years was associated with increased risk of sICH (OR, 18.2 [95% CI, 1.0–324.1], P = 0.048), and death (OR, 3.3 [95% CI, 1.2–9.1], P = 0.018), but not with functional outcome at 3 months. Other factors associated with death were longer onset to treatment time (OTT) (OR, 1.007/min increase [95% CI, 1.00–1.015], P = 0.047), higher NIHSS (OR, 1.12 per point increase [95% CI, 1.04–1.19], P = 0.001), and previous stroke (OR, 4.0 [95% CI, 1.2–13.7], P = 0.03). Predictors of good functional outcome were shorter OTT (OR, 0.99 [95% CI, 0.98–1.00], P = 0.02) and lower NIHSS (OR, 0.80 [95% CI, 0.74–0.87] P ≤ 0.001).
Age ≥80 years might be an independent risk factor for sICH and death the first 3 months after treatment with tPA for AIS, but does not influence the chance of a good functional outcome. We suggest to treat patients over 80 years with tPA, but be cautious if the time from onset (OTT) is long.