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Korean J Stroke. 2011 Aug;13(2):79-84. Korean. Original Article.
Jeong MG , Kim Y , Kim YJ , Oh MS , Yu KH , Lee BC , Lee JH , Kwon JH , Kwon SU , Heo SH , Choi JC , Kwon HM , Park JM , Kim EG , Rha JH , Park HK , Bae HJ , Han MK , Hong KS , Cho YJ , Park MS , Cho KH , Kim HY , Lee J , Kim DE , Lee SJ , Lee KB , Park TH , Cha MJ , Heo JH , Nam HS , Cha JK , Kim CH , Yoon BW .
Department of Neurology, Hallym University College of Medicine, Anyang, Korea. ssbrain@hallym.ac.kr
Department of Neurology, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea.
Department of Neurology, University of Ulsan College of Medicine, Ulsan, Korea.
Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Department of Neurology, Kyung Hee University College of Medicine, Seoul, Korea.
Department of Neurology, Jeju National University College of Medicine, Jeju, Korea.
Department of Neurology, Seoul National University Boramae Hospital, Seoul, Korea.
Department of Neurology, Eulji General Hospital, Eulji University College of Medicine, Seoul, Korea.
Department of Neurology, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea.
Department of Neurology, Inha University College of Medicine, Incheon, Korea.
Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.
Department of Neurology, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea.
Department of Neurology, Chonnam National University Medical School, Gwangju, Korea.
Department of Neurology, Konkuk University School of Medicine, Seoul, Korea.
Department of Neurology, Yeugnam University Colleage of Medicine, Daegu, Korea.
Department of Neurology, Dongguk University School of Medicine, Goyang, Korea.
Department of Neurology, Eulji University Hospital, Eulji University College of Medicine, Daejeon, Korea.
Department of Neurology, Soonchunhyang University College of Medicine, Seoul, Korea.
Department of Neurology, Seoul Medical Center, Seoul, Korea.
Department of Neurology, Yonsei University College of Medicine, Seoul, Korea.
Department of Neurology, Dong-A University College of Medicine, Busan, Korea.
Department 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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