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

Abstract

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.

Significances and Outcomes of Mechanical Thrombectomy for Acute Infarction in Very Elderly Patients : A Single Center Experience

“…Similarly, several studies 6 , 12 , 18) have shown a lower rate of good functional outcomes in patients aged 80 years and older for 3 months after intra-arterial or intravenous treatment. However, Pego et al 19) pointed out that there was no significant difference in mRS score between older and younger patients who were treated with intravenous thrombolysis. This might suggest that age-related neuronal loss leads to decreased neurological reserve, which influences the poor functional recovery seen in very elderly patients at the time of discharge as well as at 3 months follow-up.…”

Stroke Referrals from Nursing Homes: High Rate of Mimics and Late Presentation

“…Thus, in reality, only one patient received intravenous thrombolysis/mechanical thrombectomy. From the results of successful recent treatment trials of thrombolysis and endovascular recanalization (including elderly individuals), it can be assumed that this will have contributed to the very high mortality of 26% within 30 days after stroke in our sample [1-3, 17, 18]. …”

Idosos mais idosos: uma revisão da literatura

“…Avaliar o tratamento com ativador de plasminogênio para pacientes mais velhos com AVC isquêmico Park, H. J., et al (2016). Coreia do Sul 29Plos One Investigar a clínica do câncer gástrico em pacientes com ≥ 80 anos Pego, P. M., et al (2016). Portugal (30)…”

“…Quanto ao método de coleta de dados utilizado nos estudos pesquisados, verificamos uma grande diversidade de instrumentos (31 tipos diferentes). Os instrumentos mais encontrados nesta revisão relacionaram-se à avaliação funcional, em nove artigos (Bonicoli, et al, 2016;Downer, Chen, Wong, & Markides, 2016;Hegendörfer, et al, 2017b;Levinson, et al, 2016;Pego, Nunes, Ferreira, Sousa, & Amaral-Silva,, 2016;Wang, et al, 2016;Warwick, et al, 2015;Yoshida, et al, 2017;Yu, et al, 2017) e instrumentos preditores de risco, em sete artigos (Hegendörfer, et al, 2017b;Levinson, et al, 2016;Luo, et al, 2014;Mione, et al, 2016;Pego, Nunes, Ferreira, Sousa, & Amaral-Silva, 2016;Rinaldi, et al, 2017;Yoshida, et al, 2017). Para Paixão (2005), a definição da avaliação do estado funcional seria "o nível com o qual a pessoa desempenha funções e atividades da vida diária".…”