Intravenous TPA for very old stroke patients

Background: Although thrombolysis in patients with advanced age is considered more risky, some may benefit from TPA treatment. We studied safety and recanalization/ recovery in patients older than 80 years treated with TPA and compared them with younger stroke patients. Methods: We studied patients treated with intravenous TPA and divided them into younger ( ! 80 years) and older ( 6 80 years) groups for comparison. Diagnostic transcranial Doppler was completed before bolus, and patients were consequently monitored for up to 2 h when feasible. Clinical data included NIH Stroke Scale score, symptomatic intracranial hemorrhage (ICH) and discharge disposition. Results: We studied 127 younger ( mean 63 years, range 31 - 79) and 56 older patients ( mean 84 years, range 80 - 93). Median baseline NIH Stroke Scale score was higher in the older group ( 18 vs. 14 points, NS). Occlusion locations, onset to needle time ( median 130 vs. 120 min) as well as improvement at 24 h ( median 5 vs. 4 points) were similar in both groups. Transcranial Doppler monitoring showed similar partial or complete recanalization rates ( 66 vs. 66%), onset to recanalization time ( median 160 vs. 158 min) and reocclusion rates (26 vs. 25%). Symptomatic and fatal ICH was not higher in the older group (7.1 and 3.5% vs. 6.3 and 3.9%, NS). There was higher mortality among older patients (20 vs. 11%, NS). At discharge, 23% of older patients went home, 41% underwent rehabilitation and 16% were transferred to skilled nursing facilities, compared with 31, 43 and 15% respectively, in the younger group. Conclusion: After intravenous TPA treatment, patients over 80 years of age have similar recanalization, short- term improvement and symptomatic ICH rates compared with younger patients. However, older patients tend to have higher in-hospital mortality. Copyright (C) 2005 S. Karger AG, Basel.