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Outcome of intravenous recombinant tissue plasminogen activator for acute ischemic stroke in patients aged over 80 years
Author(s) -
Mione Gioia,
Ducrocq Xavier,
Thilly Nathalie,
Lacour JeanChristophe,
Vespignani Hervé,
Richard Sébastien
Publication year - 2016
Publication title -
geriatrics and gerontology international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.823
H-Index - 57
eISSN - 1447-0594
pISSN - 1444-1586
DOI - 10.1111/ggi.12565
Subject(s) - medicine , modified rankin scale , odds ratio , confidence interval , tissue plasminogen activator , stroke (engine) , cerebral infarction , fibrinolytic agent , ischemic stroke , surgery , ischemia , mechanical engineering , engineering
Aim Practitioners are faced with a substantial challenge when considering recombinant tissue plasminogen activator (rt‐ PA ) therapy for older patients with ischemic stroke. Patients aged over 80 years suffer from the most severe cerebral infarcts. The benefit of rt‐ PA treatment compared with single standard care only in stroke units remains to be clearly assessed. Methods We collected data from 321 patients aged over 80 years admitted for acute cerebral infarction to the stroke unit of Nancy University Hospital in F rance between 1 J anuary 2009 and 31 D ecember 2012. Patients were stratified into two groups: treated or not with rt‐ PA . Baseline characteristics and outcome were collected and compared between both groups. Good outcome at 3 months was defined as modified R ankin S cale score ≤2. Results The 55 patients treated with rt‐ PA had a higher N ational I nstitute of H ealth S troke S cale score on admission than those without (15 vs 5; P < 0.001). They were more likely to have intracranial haemorrhage (20 vs 5%; P < 0.001) without an increased mortality rate (28 vs 27%; P = 0.95). Multivariate analysis showed a more favorable outcome (odds ratio 7, 95% confidence interval 3–16.5; P < 0.001). Slightly higher percentages of patients with modified R ankin S cale ≤2 were found after intention‐to‐treat analysis (49 vs 45%) and after exclusion of patients with baseline modified R ankin S cale >2 (57 vs 54 %), but without reaching significance ( P > 0.05). Conclusions Rt‐ PA therapy would appear to improve prognosis in the elderly with ischemic stroke. This suggests that age alone should no longer be a barrier to rt‐ PA therapy. Geriatr Gerontol Int 2016; 16: 843–849.