Routine thrombolysis with intravenous tissue plasminogen activator in acute ischaemic stroke patients aged 80 years or older: a single centre experience

SIR—Treatment with intravenous tissue plasminogen activator (t-PA) in acute ischaemic stroke has been shown to improve outcome [1]. Little is known regarding the safety and efficacy of this treatment in patients aged 80 years and older, because this age group was underrepresented in clinical trials [1–4]. The NINDS trial [1] was the only trial without age limit and only 7% (n = 42) of the included patients were older than 80 years. However, about 30% of admitted ischaemic stroke patients are older than 80 years [5]. A number of previous observational studies compared the outcome of t-PA treatment in patients older than 80 years with their younger counterparts [6–12], and a recent systemic review suggested that t-PA is safe in older patients, despite a higher 3-month mortality and a less favourable functional outcome [13]. In this study, we compared the safety and outcome of t-PA treatment in patients aged 80 years and older with their younger counterparts in a prospective cohort from the University Medical Center Groningen (UMCG). In contrast to most previous studies, we not only investigated the 3month mortality but we also compared the early in-hospital mortality at 7 days between the two groups.