Thrombolytic Therapy for Acute Stroke in the Elderly: An Emergent Condition in Developing Countries

Martins, Sheila Cristina Ouriques; Friedrich, Maurício; Brondani, Rosane; Almeida, Alexandre Oliveira; Araujo, Mariana Dagnino; Chaves, Márcia Lorena Fagundes; Berger, Joseph R.; Massaro, Ayrton Roberto

doi:10.1016/j.jstrokecerebrovasdis.2010.02.019

Cited by 13 publications

(7 citation statements)

References 23 publications

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“…Mean age of the series was 72.30±12.34 years, and 284 patients (48.9%) were women. Median baseline NIHSS score was 15 [range [10][11][12][13][14][15][16][17][18][19][20]. According to stroke severity, the groups were categorized as 115 (19.8%) patients with mild stroke, 176 (30.3%) patients with moderate stroke, and 290 (49.9%) patients with severe stroke.…”

Section: Resultsmentioning

confidence: 99%

“…[7][8][9][10][11] Several factors have been shown to be outcome predictors after thrombolysis including baseline stroke severity age, diabetes mellitus, location of intracranial artery occlusion and extend changes on baseline CT scan. [12][13][14][15][16][17] Although the beneficial effect of IV tPA decreases progressively over time, the effects of time-to-treatment on short-and long-term outcome may vary widely depending on baseline stroke severity. Therefore, baseline National Institutes of Health Stroke Scale (NIHSS) score adjustment would further refine the influence of time-to-treatment on stroke outcome.…”

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confidence: 99%

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Baseline National Institutes of Health Stroke Scale–Adjusted Time Window for Intravenous Tissue-Type Plasminogen Activator in Acute Ischemic Stroke

Muchada

Rubiera

Rodríguez‐Luna

et al. 2014

Stroke

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Background and Purpose-The effect of tissue-type plasminogen activator on functional outcome decreases progressively over time. However, given the differential pattern of arterial occlusion, stroke severity, and speed of ischemic lesion growth among candidates for reperfusion, the time window should be adjusted accordingly. We aimed to identify the impact of time-to-treatment according to stroke severity on functional outcome in patients with acute ischemic stroke. Methods-We included 581 consecutive patients treated with alteplase according to the European Summary of Product Characteristics criteria. Patients were categorized according to National Institutes of Health Stroke Scale (NIHSS) severity in mild NIHSS (≤8), moderate NIHSS (9-15), and severe stroke NIHSS (≥16). We sequentially analyzed timeto-treatment to achieve favorable outcome (modified Rankin Scale ≤2 at 3 months

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Section: Resultsmentioning

confidence: 99%

mentioning

confidence: 99%

Baseline National Institutes of Health Stroke Scale–Adjusted Time Window for Intravenous Tissue-Type Plasminogen Activator in Acute Ischemic Stroke

Muchada

Rubiera

Rodríguez‐Luna

et al. 2014

Stroke

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“…Older patients should not be excluded from treatment, especially in Latin American countries where the burden of the disease also affects the ever-growing elderly population [34]. Of these 303 patients, 23% were 80 years or older (elderly group).…”

Section: Jg Reviewmentioning

confidence: 99%

Stroke in Latin America: Burden of Disease and Opportunities for Prevention

Avezum

Costa-Filho

Pieri

et al. 2015

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The epidemiological transition in Latin America toward older urban dwelling adults has led to the rise in cardiovascular risk factors and an increase in morbidity and mortality rates related to both stroke and myocardial infarction. As a result, there is an immediate need for effective actions resulting in better detection and control of cardiovascular risk factors that will ultimately reduce cardiovascular disease burden. Data from case-control studies have identified the following risk factors associated with stroke: hypertension; smoking; abdominal obesity; diet; physical activity; diabetes; alcohol intake; psychosocial factors; cardiac causes; and dyslipidemia. In addition to its high mortality, patients who survive after a stroke present quite frequently with marked physical and functional disability. Because stroke is the leading cause of death in most Latin American countries and also because it is a clearly preventable cause of death and disability, simple, affordable, and efficient strategies must be urgently implemented in Latin America.

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“…In summary, numerous Class III studies report prevalences of excellent functional outcomes (mRS score 0 to 1) with administration of IV tPA within 3 hours of symptom onset ranging from 37% to 53%. [26][27][28][29][30][31][32][33][34][35][36] However, registries typically included patients with less severe strokes (baseline mean or median NIHSS scores ranging from 11 to 13) compared with those enrolled in the NINDS trials.…”

Section: Potential Benefitsmentioning

confidence: 99%

“…Among the Class III cohort studies, there was substantial variability in the reported mortality prevalences, ranging from 1% to 24%. [27][28][29][30][31][33][34][35][36][37]40,45,51 Appendix D contains information on key risk-benefit concepts.…”

Section: Potential Harmsmentioning

confidence: 99%

Clinical Policy: Use of Intravenous Tissue Plasminogen Activator for the Management of Acute Ischemic Stroke in the Emergency Department

Brown¹,

Burton²,

Nazarian³

et al. 2015

Annals of Emergency Medicine

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Thrombolytic Therapy for Acute Stroke in the Elderly: An Emergent Condition in Developing Countries

Cited by 13 publications

References 23 publications

Baseline National Institutes of Health Stroke Scale–Adjusted Time Window for Intravenous Tissue-Type Plasminogen Activator in Acute Ischemic Stroke

Baseline National Institutes of Health Stroke Scale–Adjusted Time Window for Intravenous Tissue-Type Plasminogen Activator in Acute Ischemic Stroke

Stroke in Latin America: Burden of Disease and Opportunities for Prevention

Clinical Policy: Use of Intravenous Tissue Plasminogen Activator for the Management of Acute Ischemic Stroke in the Emergency Department

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