Korean J Stroke.
2012 Apr;14(1):19-28.
Effectiveness and Safety of Thrombolysis in Ischemic Stroke Patients Aged 80 Years or Older
- Affiliations
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- 1Department of Neurology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea.
- 2Department of Neurosurgery, Stroke Center, Seoul National University Bundang Hospital, Seongnam, Korea.
- 3Department of Radiology, Stroke Center, Seoul National University Bundang Hospital, Seongnam, Korea.
- 4Department of Biostatistics, Korea University College of Medicine, Seoul, Korea.
- 5Department of Neurology, Dongguk University Gyeongju Hospital, Gyeongju, Korea.
- 6Department of Neurology, Eulji University Hospital, Eulji University School of Medicine, Daejeon, Korea.
- 7Department of Neurology, Stroke Center, Seoul National University Bundang Hospital, Seongnam, Korea. braindoc@snu.ac.kr
Abstract
- BACKGROUND
Thrombolysis becomes an emerging therapeutic option for acute ischemic stroke. However, few reports exist on its use in the very elderly. We investigated whether there is a difference in the effectiveness and safety of intravenous (IV) and/or intra-arterial (IA) thrombolysis between patients aged > or =80 years and those aged <80 years.
METHODS
A consecutive series of patients hospitalized within 12 hours from stroke onset were selected. We evaluated the effectiveness of thrombolysis with modified Rankin scale (mRS) at 3 months, and the safety with symptomatic hemorrhagic transformation (sHT). The odds ratio (OR) of thrombolysis on the favorable mRS (0-2) was calculated using multivariable logistic regression analysis with adjustments for potential confounders. Whether the effectiveness of thrombolysis is age-dependent or not was analyzed by introducing an interaction term (thrombolysisxage group) into multivariable models.
RESULTS
Among 219 patients > or =80 years, 21% of patients received IV or IA or combined thrombolysis while 23% of 980 patients <80 years received thrombolysis (P=0.51). With respect to the favorable mRS, the adjusted ORs of thrombolysis were 1.70 (95% confidence interval, 1.08-2.68) in all subjects, 1.61 (0.58-4.49) in those > or =80 years, and 1.71 (1.05-2.78) in those <80 years. There was no significant interaction between age group and thrombolysis (P=0.91). With respect to sHT, the adjusted OR was 4.72 (1.94-11.45) in all subjects with no significant interaction (P=0.86).
CONCLUSION
This study suggests that thrombolysis may be equally safe and effective in stroke patients aged > or =80 years versus <80 years.
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