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Vol. 54, No. 3, 2005
Issue release date: December 2005
Eur Neurol 2005;54:140–144

Intravenous TPA for Very Old Stroke Patients

Chen C.-I. · Iguchi Y. · Grotta J.C. · Garami Z. · Uchino K. · Shaltoni H. · Alexandrov A.V.
aStroke Treatment Team, The University of Texas, Houston, Tex., USA; bDepartment of Neurology, Taipei Municipal Wan Fang Hospital managed by Taipei Medical University, Tapei, Taiwan; cStroke Center, Department of Neurology, Kawasaki Medical School, Okayama, Japan; dDepartment of Radiology and Oncotherapy, Semmelweis University, Budapest, Hungary; eDepartment of Neurology, University of Pittsburgh, Pittsburgh, Pa., fBarrow Neurological Institute, Phoenix, Ariz., USA

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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 (≧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.

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  1. Manolio TA, Kronmal RA, Burke GL, O’Leary DH, Price TR: Short-term predictors of incident stroke in older adults. The Cardiovascular Health Study. Stroke 1996;27:1479–1486.
  2. Wolf PA, D’Agostino RB, Belanger AJ, Kannel WB: Probability of stroke: a risk profile from the Framingham Study. Stroke 1991;22:312–318.
  3. Tanne D, Yaari S, Goldbourt U: Risk profile and prediction of long-term ischemic stroke mortality: a 21-year follow-up in the Israeli Ischemic Heart Disease (IIHD) Project. Circulation 1998;98:1365–1371.
  4. Di Carlo A, Lamassa M, Pracucci G, Basile AM, Trefoloni G, Vanni P, et al: Stroke in the very old: clinical presentation and determinants of 3-month functional outcome: a European perspective. European BIOMED Study of Stroke Care Group. Stroke 1999;30:2313–2319.
  5. Nakayama H, Jorgensen HS, Raaschou HO, Olsen TS: The influence of age on stroke outcome. The Copenhagen Stroke Study. Stroke 1994;25:808–813.
  6. Brown RD, Whisnant JP, Sicks JD, O’Fallon WM, Wiebers DO: Stroke incidence, prevalence, and survival: secular trends in Rochester, Minnesota, through 1989. Stroke 1996;27:373–380.
  7. Hacke W, Kaste M, Fieschi C, Toni D, Lesaffre E, von Kummer R, et al: Intravenous thrombolysis with recombinant tissue plasminogen activator for acute hemispheric stroke. The European Cooperative Acute Stroke Study (ECASS). JAMA 1995;274:1017–1025.
  8. Hacke W, Kaste M, Fieschi C, von Kummer R, Davalos A, Meier D, et al: Randomised double-blind placebo-controlled trial of thrombolytic therapy with intravenous alteplase in acute ischaemic stroke (ECASS II). Second European-Australasian Acute Stroke Study Investigators. Lancet 1998;352:1245–1251.
  9. Clark WM, Wissman S, Albers GW, Jhamandas JH, Madden KP, Hamilton S: Recombinant tissue-type plasminogen activator (Alteplase) for ischemic stroke 3–5 h after symptom onset. The ATLANTIS Study: a randomized controlled trial. Alteplase Thrombolysis for Acute Noninterventional Therapy in Ischemic Stroke. JAMA 1999;282:2019–2026.
  10. Generalized efficacy of t-PA for acute stroke: subgroup analysis of the NINDS t-PA Stroke Trial. Stroke 1997;28:2119–2125.
  11. Tanne D, Gorman MJ, Bates VE, Kasner SE, Scott P, Verro P, et al: Intravenous tissue plasminogen activator for acute ischemic stroke in patients aged 80 years and older: the tPA stroke survey experience. Stroke 2000;31:370–375.
  12. Demchuk AM, Christou I, Wein TH, Felberg RA, Malkoff M, Grotta JC, et al: Accuracy and criteria for localizing arterial occlusion with transcranial Doppler. J Neuroimaging 2000;10:1–12.
  13. Burgin WS, Malkoff M, Felberg RA, Demchuk AM, Christou I, Grotta JC, et al: Transcranial Doppler ultrasound criteria for recanalization after thrombolysis for middle cerebral artery stroke. Stroke 2000;31:1128–1132.
  14. Adams HP Jr, Bendixen BH, Kappelle LJ, Biller J, Love BB, Gordon DL, et al: Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment. Stroke 1993;24:35–41.
  15. Intracerebral hemorrhage after intravenous t-PA therapy for ischemic stroke: The NINDS t-PA Stroke Study Group. Stroke 1997;28:2109–2118.
  16. Larrue V, von Kummer R, del Zoppo G, Bluhmki E: Hemorrhagic transformation in acute ischemic stroke. Potential contributing factors in the European Cooperative Acute Stroke Study. Stroke 1997;28:957–960.
  17. Larrue V, von Kummer RR, Muller A, Bluhmki E: Risk factors for severe hemorrhagic transformation in ischemic stroke patients treated with recombinant tissue plasminogen activator: a secondary analysis of the European-Australasian Acute Stroke Study (ECASS II). Stroke 2001;32:438–441.
  18. Wardlaw JM, del Zoppo G, Yamaguchi T, Berge E: Thrombolysis for acute ischemic stroke (Cochrane Review). Cochrane Database Syst Rev, issue 3, 2003.
  19. Alexandrov AV, Bladin CF, Norris JW: Intracranial blood flow velocities in acute ischemic stroke. Stroke 1994;25:1378–1383.
  20. Olindo S, Cabre P, Deschamps R, Chatot-Henry C, Rene-Corail P, Fournerie P, et al: Acute stroke in the very elderly: epidemiological features, stroke subtypes, management, and outcome in Martinique, French West Indies. Stroke 2003;34:1593–1597.

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