Korean J Stroke.
2011 Aug;13(2):79-84.
The Factors Associated with the Decision of r-tPA Use in Acute Ischemic Stroke Patients Aged 80 Years or Older
- Affiliations
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- 1Department of Neurology, Hallym University College of Medicine, Anyang, Korea. ssbrain@hallym.ac.kr
- 2Department of Neurology, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea.
- 3Department of Neurology, University of Ulsan College of Medicine, Ulsan, Korea.
- 4Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
- 5Department of Neurology, Kyung Hee University College of Medicine, Seoul, Korea.
- 6Department of Neurology, Jeju National University College of Medicine, Jeju, Korea.
- 7Department of Neurology, Seoul National University Boramae Hospital, Seoul, Korea.
- 8Department of Neurology, Eulji General Hospital, Eulji University College of Medicine, Seoul, Korea.
- 9Department of Neurology, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea.
- 10Department of Neurology, Inha University College of Medicine, Incheon, Korea.
- 11Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.
- 12Department of Neurology, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea.
- 13Department of Neurology, Chonnam National University Medical School, Gwangju, Korea.
- 14Department of Neurology, Konkuk University School of Medicine, Seoul, Korea.
- 15Department of Neurology, Yeugnam University Colleage of Medicine, Daegu, Korea.
- 16Department of Neurology, Dongguk University School of Medicine, Goyang, Korea.
- 17Department of Neurology, Eulji University Hospital, Eulji University College of Medicine, Daejeon, Korea.
- 18Department of Neurology, Soonchunhyang University College of Medicine, Seoul, Korea.
- 19Department of Neurology, Seoul Medical Center, Seoul, Korea.
- 20Department of Neurology, Yonsei University College of Medicine, Seoul, Korea.
- 21Department of Neurology, Dong-A University College of Medicine, Busan, Korea.
- 22Department of Neurology, Seoul National University College of Medicine, Seoul, Korea.
Abstract
- BACKGROUND
Small proportions of all the elderly stroke patients receive recombinant tissue plasminogen activator (r-tPA) therapy, although old age is not a proven contraindication to intravenous thrombolytic therapy for acute ischemic stroke. The purpose of this study was to identify reasons for exclusion from r-tPA therapy and factors associated with the decision of r-tPA use in elderly patients with acute ischemic stroke.
METHODS
From the acute stroke registries of 22 domestic university hospitals taking the r-tPA therapy from January 2007 to May 2010, we extracted data of all acute ischemic stroke patients who were aged 80 or over and arrived within onset 3 hours. For all patients, we assessed the eligibility of r-tPA therapy using National Institute of Neurological Disorders and Stroke (NINDS) r-tPA trial criteria. For eligible patients, we compared all clinical variables between patients who were treated with r-tPA and those who were not, and analyzed potential factors related to the decision of r-tPA use.
RESULTS
A total of 494 patients were included in this study. 255 patients (51.6%) were excluded by NINDS r-tPA trial criteria and the major reasons for exclusion were minor neurological deficit (53.7%) and clinical improvement (17.3%). Among 239 patients who were eligible for r-tPA, 162 (32.8%) patients received r-tPA and 77 (15.6%) did not. Multivariable analysis showed that younger age, shorter time-delay from onset to admission, non-smoker, no history of prior stroke, good pre-stroke functional status and severe initial neurological deficit were independently associated with the decision of r-tPA use in the elderly stroke patients predictors for r-tPA treatment.
CONCLUSION
In very elderly patients, mild neurological deficit on arrival and rapid clinical improvement in neurological symptoms were the main reasons for exclusion from thrombolytic therapy.
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