Key summary points
Evaluate clinical and functional outcomes of centenarians treated with intravenous thrombolysis for acute ischemic stroke.
AbstractSection FindingsThree out of four patients were functionally independent 90 days after discharge. No serious hemorrhagic or systemic adverse events secondary to treatment were registered..
AbstractSection MessageIntravenous thrombolysis may be beneficial in patients over 100 years.
Abstract
Purpose
The benefit of intravenous alteplase is well established for patients with disabling stroke symptoms regardless of age, although data on outcomes in centenarian patients are scarce. We present our experience in patients beyond 100 years.
Methods
Descriptive study including centenarians from our single-centre prospective registry who underwent intravenous thrombolysis with alteplase for acute ischemic stroke in our tertiary university hospital. Clinical variables and functional outcome at 3 months were collected.
Results
Four patients, all women, functionally independent (mRS ≤ 2) were included. Treatment with alteplase was applied within 4.5 h of stroke onset. One patient complicated with pneumonia and died. Two patients were functionally independent (mRS ≤ 2) at discharge, while the third was partially dependent (mRS of 3 at discharge), improving after 3 months, (mRS 2). No serious hemorrhagic or systemic adverse events were registered.
Conclusion
In our experience, intravenous thrombolysis may be beneficial and should be considered in patients over 100 years old with no previous disability.
This is a preview of subscription content, log in via an institution to check access.
References
Wilkins E, Wilson L, Wickramasinghe K et al. (2017) European Cardiovascular Disease Statistics 2017. Brussels: European Heart Network. http://www.ehnheart.org/cvd-statistics/cvd-statistics-2017.html. Accessed 1 Dec 2020
Stroke Alliance for Europe (SAFE) (2017) The burden of stroke in Europe: The challenge for policy makers. SAFE. https://www.stroke.org.uk/sites/default/files/the_burden_of_stroke_in_europe_-_challenges_for_policy_makers.pdf. Accessed 1 Dec 2020
Wafa HA, Wolfe CDA, Emmett E et al (2020) Burden of stroke in Europe: thirty-year projections of incidence, prevalence, deaths, and disability-adjusted life years. Stroke 51(8):2418–2427. https://doi.org/10.1161/STROKEAHA.120.029606
United Nations, Department of Economic and Social Affairs, Population Division. World population prospects: the 2019 revision. https://population.un.org/wpp/. Accessed 1 Dec 2020
National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group (1995) Tissue plasminogen activator for acute ischemic stroke. N Engl J Med 333(24):1581–1587
Wardlaw JM, Murray V, Berge E et al (2009) Thrombolysis for acute ischaemic stroke. Cochrane Database Syst Rev 4:CD000213. https://doi.org/10.1002/14651858.CD000213.pub2
Sandercock P, Wardlaw JM, Lindley RI, the IST-3 Collaborative Group et al (2012) The benefits and harms of intravenous thrombolysis with recombinant tissue plasminogen activator within 6 h of acute ischaemic stroke (the third international stroke trial [IST-3]): a randomised controlled trial. Lancet 379:2352–2363. https://doi.org/10.1016/S0140-6736(12)60768-5
García-Caldentey J, de Leciñana MA, Simal P et al (2012) Intravenous thrombolytic treatment in the oldest old. Stroke Res Treat 2012:923676. https://doi.org/10.1155/2012/923676
Lyden P, Raman R, Liu L et al (2009) National Institutes of Health Stroke Scale certification is reliable across multiple venues. Stroke 40:2507–3251. https://doi.org/10.1161/STROKEAHA.108.532069
Olsen TS, Andersen KK (2014) Stroke in centenarians. Geriatr Gerontol Int 14(1):84–88. https://doi.org/10.1111/ggi.12058
Gorman MJ, Tanne D, Lewandowski CA (2002) Centenarian stroke treated with tissue-type plasminogen activator. Cerebrovasc Dis 13(4):285–287. https://doi.org/10.1159/000057857
Behrouz R, Masjuán-Vallejo J, Vera R (2018) Outcomes of nonagenarians with acute ischemic stroke treated with intravenous thrombolytics. J Stroke Cerebrovasc Dis 27(1):246–256. https://doi.org/10.1016/j.jstrokecerebrovasdis.2017.08.031
Bhatnagar P, Sinha D, Parker RA et al (2011) Intravenous thrombolysis in acute ischaemic stroke: a systematic review and meta-analysis to aid decision making in patients over 80 years of age. J Neurol Neurosurg Psychiatry 82(7):712–717. https://doi.org/10.1136/jnnp.2010.223149
Emberson J, Lees KR, Lyden P et al (2014) Effect of treatment delay, age, and stroke severity on the effects of intravenous thrombolysis with alteplase for acute ischaemic stroke: a meta-analysis of individual patient data from randomised trials. Lancet 384(9958):1929–1935. https://doi.org/10.1016/S0140-6736(14)60584-5
Ringleb PA, Bousser MG, Ford G, European Stroke Organisation (ESO) Executive Committee; ESO Writing Committee et al (2008) Guidelines for management of ischaemic stroke and transient ischaemic attack 2008. Cerebrovasc Dis. 25:457–507. https://doi.org/10.1159/000131083
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
On behalf of all authors, the corresponding author states that there is no conflict of interests.
Ethical approval
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent
Informed consent was waived due to the retrospective nature of the study. Consent for publication was waived for this anonymized retrospective study.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Baena Álvarez, B., García-Madrona, S., Sainz Amo, R. et al. Intravenous thrombolysis for acute ischemic stroke in centenarians. Eur Geriatr Med 12, 893–897 (2021). https://doi.org/10.1007/s41999-021-00494-4
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s41999-021-00494-4