Effectiveness and Safety of Thrombolysis in Ischemic Stroke Patients Aged 80 Years or Older

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 ≥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 modifi ed 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 (thrombolysis×age group) into multivariable models. Results: Among 219 patients ≥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% confi dence interval, 1.08-2.68) in all subjects, 1.61(0.58-4.49) in those ≥80 years, and 1.71 (1.05-2.78) in those <80 years. There was no signifi cant 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 signifi cant interaction (P =0.86). Conclusion: This study suggests that thrombolysis may be equally safe and effective in stroke patients aged ≥80 years versus <80 years.