Thrombolysis for acute ischaemic stroke

Wardlaw, Joanna M.; Zoppo, Gregory J. del; Yamaguchi, Takenori; Berge, Eivind

doi:10.1002/14651858.cd000213

Cited by 458 publications

(491 citation statements)

References 86 publications

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“…Severe disability/death (mRS score [5][6] 86 (16.8) 71 (16) 15 ( significant differences in favorable outcome or independent outcome at day 90 between younger and older patients. Most previous studies had shown lower rates of favorable and independent outcomes at day 90 in patient aged over 80 years old.…”

Section: Article In Pressmentioning

confidence: 99%

“…5 This seems to be related with frequent under-representation or exclusion of patients over the age of 80 years from clinical trials leading to uncertainty about the risk-benefit profile in these patients. 6 Data regarding IV-rtPA treatment in this age group are conflicting and result mainly from observational studies. Most studies seem to show worse outcome and increased mortality in patients aged over 80 years old with acute ischemic stroke treated with IV-rtPA when compared with younger counterparts.…”

Section: Introductionmentioning

confidence: 99%

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Thrombolysis in Patients Aged over 80 Years Is Equally Effective and Safe

Pego

Nunes

Ferreira

et al. 2016

Journal of Stroke and Cerebrovascular Diseases

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Background: Despite stroke's high prevalence in the elderly, intravenous thrombolysis is licensed in Europe only for patients younger than 80 years old. We aimed to compare the functional outcomes and complication rates in patients older versus younger than 80 years old treated with intravenous thrombolysis. Methods: A retrospective observational study of patients who received intravenous thrombolysis in a stroke unit between January 1, 2009, and June 30, 2012, was conducted. Variables were compared between 2 subgroups (≤80 and >80 years). Results: Overall, 512 patients underwent intravenous thrombolysis, of which 13.1% were over 80 years. The mean age was 65.4 years in the younger subgroup and 82.9 years in the older subgroup. Prior independence rates did not differ between the subgroups. Prevalence of atrial fibrillation and cardioembolic stroke was higher in the older subgroup (P = .004 and .026). Only 3% of the elderly with atrial fibrillation were taking oral anticoagulants. Symptoms-to-needle time was lower in the older subgroup (P = .048). Stroke severity was higher in patients over 80 years (P = .026). There was significant improvement in the National Institutes of Health Stroke Scale score 7 days after intravenous thrombolysis (P < .001) in both subgroups. The proportion of patients with 3 months' favorable outcome and independence, hemorrhagic transformation, and mortality rates were similar in both subgroups. Conclusions: Elderly patients' benefits and outcomes from intravenous thrombolysis treatment were identical to the younger subgroup without excess hemorrhagic transformation or mortality. These results favor the use of intravenous thrombolysis in patients over 80 years. Key Words: Stroke-elderlythrombolysis-over 80 years.

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Section: Article In Pressmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Thrombolysis in Patients Aged over 80 Years Is Equally Effective and Safe

Pego

Nunes

Ferreira

et al. 2016

Journal of Stroke and Cerebrovascular Diseases

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“…Urgent revascularization strategies were first applied in the late 1980s among patients with acute coronary syndromes as compared with the early 2000s in ischemic stroke patients. 5 Despite the rapid implementation of acute revascularization strategies in the management of stroke, to date a limited proportion of patients presenting in clinical practice are eligible for such treatment. 6 Finally, stroke events are a major cause of disability in adults, which may contribute to the higher risk of death after stroke compared with CHD.…”

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confidence: 99%

All-Cause Mortality up to and After Coronary Heart Disease and Stroke Events in European Middle-Aged Men

Majed

Montaye

Wagner

et al. 2015

Stroke

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A ll-cause mortality risk has seldom been compared between the period up to and the period after coronary heart disease (CHD) and stroke. Such unified epidemiological approach allows quantifying the effect of CHD and stroke events on all-cause mortality relative to a baseline risk period. We addressed this issue within the Prospective Epidemiological Study of Myocardial Infarction (PRIME). Methods Study Population and Case AscertainmentThe study population comprised 10 424 men 50 to 59 years of age who were recruited in 1991-1994 from 4 WHO MONICA centers in France (N=7855) and Northern Ireland (N=2747) and followed up for all-cause mortality over 10 years. 1 Incident CHD (stable and unstable angina, myocardial infarction, and coronary death) and ischemic stroke events were adjudicated as reported previously. 1,2 Study PeriodsAll-cause mortality in the period up to CHD and stroke, including deaths that occurred within 28 days of such events, was investigated in the entire study population. All cause mortality in the period after CHD or stroke was investigated in those who survived >28 days after such events. Statistical AnalysisHazard ratios and 95% confidence intervals of all-cause mortality were estimated by Cox's proportional hazards models using intercurrent CHD and stroke events as time-dependent covariates (Simple Model). 3 Hazard ratios were further adjusted for country and Background and Purpose-The aim was to investigate prospectively the all-cause mortality risk up to and after coronary heart disease (CHD) and stroke events in European middle-aged men. Methods-The study population comprised 10 424 men 50 to 59 years of age recruited between 1991 and 1994 in France (N=7855) and Northern Ireland (N=2747) within the Prospective Epidemiological Study of Myocardial Infarction. Incident CHD and stroke events and deaths from all causes were prospectively registered during the 10-year follow-up. In Cox's proportional hazards regression analysis, CHD and stroke events during follow-up were used as time-dependent covariates. Results-A total of 769 CHD and 132 stroke events were adjudicated, and 569 deaths up to and 66 after CHD or stroke occurred during follow-up. After adjustment for study country and cardiovascular risk factors, the hazard ratios of allcause mortality were 1.58 (95% confidence interval 1.18-2.12) after CHD and 3.13 (95% confidence interval 1. ResultsMean age was 54.90 (SD 2.89) years. During follow-up, 741 men experienced CHD, 104 stroke, and 28 both events; 9551 remained free of CHD and stroke. All-Cause Mortality RatesIn the period up to CHD and stroke, 569 deaths occurred, including 494 among men who remained free of CHD and stroke. In the period after CHD and stroke, 66 deaths occurred among 798 men who survived at least 28 days after their event.The crude annual all-cause mortality rates by study periods are reported in Table 1, overall and by subgroups. Hazard Ratios of All-Cause MortalityAfter adjustment for cardiovascular risk factors and country (Model 1), hazard ratios of all-cause ...

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“…8 The policy committee downgraded this meta-analysis to Class III evidence based on overall heterogeneity. The committee, however, did not mention that the Cochrane review also included a subgroup of 1,779 patients across six trials that had homogeneity and revealed a significant benefit of tPA administered within 3 hours (odds ratio [OR] = 0.65, 95% confidence interval [CI] = 0.54 to 0.80; p < 0.0001).…”

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confidence: 99%