Safety and Efficacy of Intravenous Thrombolytic Therapy of Cerebral Infarction in Patients over 80 Years of Age

Česká verzia

Authors: M. Petrovicsová ¹; P. Kadlecová ²; D. Václavík ³; D. Šaňák ⁴; P. Ševčík ⁵; O. Škoda ⁶; R. Herzig ⁴; D. Školoudík ⁷; Z. Kalita ⁸; R. Mikulík ^2,9
Authors place of work: Neurologické oddělení, Nemocnice Znojmo, příspěvková organizace ¹; Mezinárodní centrum klinického výzkumu (ICRC), FN u sv. Anny v Brně ²; Neurologické oddělení, Vítkovická nemocnice a. s., Ostrava-Vítkovice ³; Neurologická klinika LF UP a FN Olomouc ⁴; Neurologická klinika LF UK a FN Plzeň ⁵; Neurologické oddělení, Nemocnice Jihlava, příspěvková organizace ⁶; Neurologická klinika LF OU a Fakultní nemocnice Ostrava ⁷; Neurologické oddělení, Krajská nemocnice T. Bati, a. s., Zlín ⁸; I. neurologická klinika, FN u sv. Anny v Brně ⁹
Published in the journal: Cesk Slov Neurol N 2012; 75/108(5): 581-585
Category: Original Paper

Summary

Background:
The benefit and risk of intravenous thrombolysis administered within 4.5 hours of symptom onset in over 80 years old patients with acute ischemic stroke is not well defined.

Aim:
To evaluate Czech data on the safety and efficacy of intravenous thrombolysis in patients older than 80 years.

Methods:
Czech Republic data recorded in the SITS registry (Safe Implementation of Treatments in Stroke) on patients treated with intravenous thrombolysis between Feb/2003 and Feb/2010 were analyzed. Mortality, the incidence of symptomatic intracerebral haemorrhage (SICH) and functional recovery following intravenous thrombolysis in patients >80 versus ≤80 years of age were compared. Multiple logistic regression analysis was used to adjust association between age and the outcome measures of baseline differences.

Results:
A total of 3,053 patients were treated with intravenous thrombolysis within 4.5 hours of symptom onset and, of these, 247 (8%) were >80 years old and 2,806 (92%) were ≤80 years old. In different stroke centres in the Czech Republic, patients >80 years of age represented 0–27% of all patients treated with intravenous thrombolysis. Patients >80 years old compared with those ≤80 years old had an identical rate of intracerebral haemorrhage (OR 1.08, 95% CI: 0.64 to 1.82), about two times higher mortality rate (OR 1.99, 95% CI: 1.37 to 2.90) and a tendency to less likely achieve modified Rankin scale 0–1 at three months (OR 0.77, 95% CI: 0.54 to 1.09).

Conclusion:
Patients >80 years old are being excluded from treatment with intravenous thrombolysis, even though intravenous thrombolysis has a similar safety profile in patients over 80 years as in younger patients. Our results are in accordance with the published data and suggest that there is no reason to exclude patients older than 80 years from treatment with intravenous thrombolysis.

Key words:
thrombolysis – cerebral infarction – elderly patients

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