Experiences With Intravenous Thrombolysis in Acute Ischemic Stroke by Elderly Patients–A “Real World Scenario”

Abstract

Objectives: This retrospective single-center study aimed to investigate the risk factors, outcomes and complication rates in patients older vs. younger than 80 years treated with intravenous alteplase.Methods: Data of 1,253 thrombolysed patients were analyzed between January 1, 2004 and August 31, 2016. Vascular risk factors, stroke severity based on the NIHSS score, functional outcome using modified Rankin Scale (mRS), mortality and symptomatic intracerebral hemorrhage (SICH) were compared between two subgroups (<80 and ≥80 years).Results: 1,125 patients were included, 199 (17.6%) among them were aged over 80 years, majority (63.3%) were female (p < 0.00001). Mean age was 68.2 ± 12.4 years, i.e., 64.7 ± 10.8 years and 84.3 ± 3.4 years in the younger and the older groups, respectively (p < 0.001). Atrial fibrillation and pre-stroke anticoagulation among patients over 80 years was more likely (p < 0.0005 and p = 0.02, respectively). NIHSS scores on admission and at 24 h were higher in elderly patients (p < 0.0001). ASPECT score at 24 h was less favorable in elderly patients (p = 0.007) and was associated with worse outcome. At 3 months, 59.8% of the patients from the older group had an unfavorable outcome (p < 0.0001), however 34.7% had independent outcome. The one-year- survival was significantly worse in the older group (p < 0.0001). The incidence of SICH was lower among older patients. In a logistic regression model, atrial fibrillation, heart failure, diabetes mellitus and smoking were proven as a significant independent risk factors for worse outcome.Conclusion: Although, the outcomes were less favorable in patients over 80 years of age, our results support the feasibility of using intravenous thrombolysis among patients over 80 years of age.

Prognostic significance of age in patients with acute ischaemic stroke treated with intravenous thrombolysis

“…Our findings accord with a recent study performed on more than 500 rural residents of Poland that also revealed greater mortality and higher rate of functional dependence in thrombolysed patients aged 80 or more years compared to the remainder [11]. Similar conclusions came from a study of a Hungarian cohort comprising more than 1,000 AIS patients treated with IVT: this also showed a significantly lower chance of 1-year survival in the elderly [12]. Data coming from a previous systematic review of six studies including more than 2,000 AIS patients, among whom nearly one in four were aged 80 or more, also supported the results of our study [6].…”

“…Patients aged 80 or more who had mRS 3-6 90 days after stroke onset (n = 53) compared to those with favourable outcome (n = 49) had higher NIHSS score on admission (16 [14-20] vs. 7 [5][6][7][8][9][10][11][12], p < 0.001) and after IVT (15 [8][9][10][11][12][13][14][15][16][17][18] vs. 2 [1-6], p < 0.001), more often had haemorrhagic brain complications after IVT (35.85% vs. 8.16%, p < 0.001) and premorbid disability (pre-stroke mRS score ≥ 1: 28.30% vs. 8.16%, p = 0.010), less often had fasting glucose level below 5.5 mmol/L (9.43% vs. 26.53%, p = 0.023), had higher CRP levels (27.2 [9.1-84.1] vs. 4.3 [2.1-10.3] mg/L, p < 0.001), and had higher maximal diastolic blood pressure within 24 hours after IVT (80 [72-90] vs. 80 [70-85] mmHg, p = 0.026) (Supplemental Tab. 1).…”

“…1). Patients below 60 who had mRS 3-6 90 days after stroke onset (n = 10) compared to those with a favourable outcome (n = 59) more often suffered from hypertension (90.00% vs. 54.24%, p = 0.033), more often underwent MT (90.00% vs. 38.98%, p = 0.028), had higher NIHSS score on admission (19 [18-20] vs. 9 [5][6][7][8][9][10][11][12][13][14][15][16], p = 0.005) and after IVT (19 [15][16][17][18][19] vs. 4 [2][3][4][5][6][7][8], p < 0.001), more often had haemorrhagic brain complications after IVT (70.00% vs. 14.56%, p < 0.001), and had higher CRP levels (9.3 [7.2-14.0] vs. 4.0 [1.5-7.7] mg/L, p = 0.018) (Supplemental Tab. 1).…”

“…Patients aged 80 or more who had mRS 3-6 90 days after stroke onset (n = 13) compared to those with a favourable outcome (n = 6) had a higher NIHSS score after IVT (15 [8][9][10][11][12][13][14][15][16][17][18][19] vs. 4 [2-10], p = 0.018) (Supplemental Tab. 4).…”

“…4). Patients below 60 who had mRS 3-6 90 days after stroke onset (n = 9) compared to those with a favourable outcome (n = 23) had higher NIHSS score on admission (19 [18-20] vs. 16 [10][11][12][13][14][15][16][17][18], p = 0.015) and after IVT (19 [16][17][18][19] vs. 6 [3][4][5][6][7][8][9][10][11], p < 0.001) and more often had haemorrhagic brain complications after IVT (77.78% vs. 26.09%, p = 0.031) (Supplemental Tab. 4).…”