Intravenous tissue plasminogen activator for acute ischemic stroke in patients aged 80 years and older - The tPA Stroke Survey Experience

Background and Purpose-Intravenous tissue plasminogen activator (tPA) admin istered within 3 hours of symptom onset is the first available effective th erapy for acute ischemic stroke (AIS). Few data exist, however, on its use in very elderly patients. We examined the characteristics, complications, a nd short-term outcome of AIS patients aged greater than or equal to 80 year s treated with tPA. Methods-Patients aged greater than or equal to 80 years (n = 30) were compa red with counterparts aged <80 years (n = 159) included in the tPA Stroke S urvey, a US retrospective survey of 189 consecutive AIS patients treated wi th intravenous tPA at 13 hospitals. Results-Risk of intracerebral hemorrhage (fatal, symptomatic. and total) wa s 3%, 3%, and 7% in the elderly age group and 2%, 6% and 9%, respectively, in their younger counterparts (P = NS fur all comparisons). Likelihood of f avorable outcome, defined as modified Rankin score 0 to 1, National Institu tes of Health Stroke Scale score less than or equal to 5, or marked improve ment by hospital discharge, was comparable between groups (37%, 54%, and 43 % versus 30%, 54%, and 43%, respectively; P = NS for all comparisons). Elde rly patients were more likely to be treated by stroke specialists (87% vers us 60%; P = 0.005) and less likely to have an identified protocol deviation (13% versus 33%: P = 0.03). Elderly patients were discharged more often to nursing care facilities (17% versus 5%; P = 0.003). In logistic regression models there were no differences in odds ratio for favorable or poor outco me, other than tendency for higher in-hospital mortality in elderly patient s (odds ratio, 2.8; 95% CI, 0.81 to 9.62; P = 0.10). Conclusions-Among AIS patients treated with intravenous tPA. age-related di fferences in characteristics and disposition were identified. No evidence f or withholding tPA treatment for AIS in appropriately selected patients age d greater than or equal to 80 years was identified.