Skip to main content

Advertisement

SpringerLink
Log in

Intravenous thrombolysis for acute cerebral ischaemia in old stroke patients ≥80 years of age

  • Original Article
  • Published:
Journal of Neurology Aims and scope Submit manuscript

Abstract

Despite increasing life expectancy, few data exist on the outcome of elderly stroke patients treated with IV thrombolysis. We analyzed the prospectively collected data from the Lille University Hospital stroke unit on patients treated with IV rt-PA within 4.5 h, comparing patients ≥80 years to younger ones. We considered the following outcomes: neurological improvement at the acute phase (NIHSS 0 or 1 at 24 h, or if the difference between NIHSS at 24 h and at baseline was ≥4), occurrence of intracerebral haemorrhage, mortality and functional outcome in survivors (favourable if mRS ≤2 or equal to pre-stroke score) at 3 months. Predictors of vital and functional outcome were determined using logistic regression analysis. Four hundred patients were treated with IV rt-PA, 98 (25%) being ≥80 years. The proportion of patients with neurological improvement at the acute phase (31 vs. 40%, OR 0.7, 95%CI 0.4–1.2), and with ICH (19 vs. 21%, OR 0.9, 95%CI 0.5–1.7) was similar among older and younger patients. At 3 months, 35% of patients ≥80 years had died; 52% of survivors had favourable functional outcome. Using multivariate analysis, age ≥80 years was an independent predictor of death (3.4; 95%CI 1.6–7.3), and of reduced likelihood of favourable functional outcome in survivors (OR 0.3; 95%CI 0.2–0.7) at 3 months. Although outcome at 3 months is worse for older patients than for their younger counterparts, our results are encouraging with a similar proportion of patients with early neurological improvement and with ICH in old and young patients and about half of the survivors having a favourable functional outcome in patients ≥80 years.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Feigin VL, Lawes CM, Bennett DA, Barker-Collo SL, Parag V (2009) Worldwide stroke incidence and early case fatality reported in 56 population-based studies: a systematic review. Lancet Neurol 8:355–369

    Article  PubMed  Google Scholar 

  2. Manton KG, Lamb VL, Gu X (2007) Medicare cost effects of recent U.S. disability trends in the elderly: future implications. J Aging Health 19:359–381

    Article  PubMed  Google Scholar 

  3. Engelter ST, Bonati LH, Lyrer PA (2006) Intravenous thrombolysis in stroke patients of > or = 80 versus <80 years of age–a systematic review across cohort studies. Age Ageing 35:572–580

    Article  PubMed  Google Scholar 

  4. Sylaja PN, Cote R, Buchan AM, Hill MD, Canadian Alteplase for Stroke Effectiveness Study (CASES) Investigators (2006) Thrombolysis in patients older than 80 years with acute ischaemic stroke: Canadian Alteplase for Stroke Effectiveness Study. J Neurol Neurosurg Psychiatry 77:826–829

    Article  PubMed  CAS  Google Scholar 

  5. Förster A, Szabo K, Kreisel S, Shah YP, Kern R, Griebe M, Hennerici MG (2011) Thrombolysis in very old people with stroke: stroke subtypes, patterns, complications, and clinical outcome. J Am Geriatr Soc 59:178–180

    Article  PubMed  Google Scholar 

  6. Tanne D, Gorman MJ, Bates VE, Kasner SE, Scott P, Verro P, Binder JR, Dayno JM, Schultz LR, Levine SR (2000) Intravenous tissue plasminogen activator for acute ischemic stroke in patients aged 80 years and older: the tPA stroke survey experience. Stroke 31:370–375

    Article  PubMed  CAS  Google Scholar 

  7. Ringleb PA, Schwark Ch, Köhrmann M, Külkens S, Jüttler E, Hacke W, Schellinger PD (2007) Thrombolytic therapy for acute ischaemic stroke in octogenarians: selection by magnetic resonance imaging improves safety but does not improve outcome. J Neurol Neurosurg Psychiatry 78:690–693

    Article  PubMed  CAS  Google Scholar 

  8. Meseguer E, Labreuche J, Olivot JM, Abboud H, Lavallee PC, Simon O, Cabrejo L, Echeverria A, Klein IF, Mazighi M, Amarenco P (2008) Determinants of outcome and safety of intravenous rt-PA therapy in the very old: a clinical registry study and systematic review. Age Ageing 37:107–111

    Article  PubMed  Google Scholar 

  9. Longstreth WT Jr, Katz R, Tirschwell DL, Cushman M, Psaty BM (2010) Intravenous tissue plasminogen activator and stroke in the elderly. Am J Emerg Med 28:359–363

    Article  PubMed  Google Scholar 

  10. Meretoja A, Putaala J, Tatlisumak T, Atula S, Artto V, Curtze S, Häppölä O, Lindsberg PJ, Mustanoja S, Piironen K, Pitkäniemi J, Rantanen K, Sairanen T, Salonen O, Silvennoinen H, Soinne L, Strbian D, Tiainen M, Kaste M (2010) Off-label thrombolysis is not associated with poor outcome in patients with stroke. Stroke 41:1450–1458

    Article  PubMed  Google Scholar 

  11. Ford GA, Ahmed N, Azevedo E, Grond M, Larrue V, Lindsberg PJ, Toni D, Wahlgren N (2010) Intravenous alteplase for stroke in those older than 80 years old. Stroke 41:2568–2574

    Article  PubMed  Google Scholar 

  12. Gómez-Choco M, Obach V, Urra X, Amaro S, Cervera A, Vargas M, Chamorro A (2008) The response to IV rt-PA in very old stroke patients. Eur J Neurol 15:253–256

    Article  PubMed  Google Scholar 

  13. Toni D, Lorenzano S, Agnelli G, Guidetti D, Orlandi G, Semplicini A, Toso V, Caso V, Malferrari G, Fanucchi S, Bartolomei L, Prencipe M (2008) Intravenous thrombolysis with rt-PA in acute ischemic stroke patients aged older than 80 years in Italy. Cerebrovasc Dis 25:129–135

    Article  PubMed  CAS  Google Scholar 

  14. Mishra NK, Diener HC, Lyden PD, Bluhmki E, Lees KR, VISTA Collaborators (2010) Influence of age on outcome from thrombolysis in acute stroke: a controlled comparison in patients from the Virtual International Stroke Trials Archive (VISTA). Stroke 41:2840–2848

    Article  PubMed  Google Scholar 

  15. Mishra NK, Ahmed N, Andersen G, Egido JA, Lindsberg PJ, Ringleb PA, Wahlgren NG, Lees KR, VISTA collaborators, SITS collaborators (2010) Thrombolysis in very elderly people: controlled comparison of SITS International Stroke Thrombolysis Registry and Virtual International Stroke Trials Archive. BMJ 23:341–350

    Google Scholar 

  16. Bodenant M, Leys D, Debette S, Cordonnier C, Dumont F, Hénon H, Girot M, Lucas C, Devos D, Defebvre L, Deplanque D, Leclerc X, Bordet R (2010) Intravenous thrombolysis for acute cerebral ischaemia: comparison of outcomes between patients treated at working versus nonworking hours. Cerebrovasc Dis 30:148–156

    Article  PubMed  Google Scholar 

  17. The National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group (1995) Tissue plasminogen activator for acute ischemic stroke. N Engl J Med 333:1581–1587

    Article  Google Scholar 

  18. Hacke W, Kaste M, Fieschi C, Toni D, Lesaffre E, von Kummer R, Boysen G, Bluhmki E, Höxter G, Mahagne MH et al (1995) Intravenous thrombolysis with recombinant tissue plasminogen activator for acute hemispheric stroke. The European Cooperative Acute Stroke Study (ECASS). JAMA 274:1017–1025

    Article  PubMed  CAS  Google Scholar 

  19. Hacke W, Kaste M, Bluhmki E, Brozman M, Dávalos A, Guidetti D, Larrue V, Lees KR, Medeghri Z, Machnig T, Schneider D, von Kummer R, Wahlgren N, Toni D, Investigators ECASS (2008) Thrombolysis with alteplase 3 to 4.5 hours after acute ischemic stroke. N Engl J Med 359:1317–1329

    Article  PubMed  CAS  Google Scholar 

  20. Wahlgren N, Ahmed N, Dávalos A, Ford GA, Grond M, Hacke W, Hennerici MG, Kaste M, Kuelkens S, Larrue V, Lees KR, Roine RO, Soinne L, Toni D, Vanhooren G, SITS-MOST investigators (2007) Thrombolysis with alteplase for acute ischaemic stroke in the Safe Implementation of Thrombolysis in Stroke-Monitoring Study (SITS-MOST): an observational study. Lancet 369:275–282

    Article  PubMed  CAS  Google Scholar 

  21. Hacke W, Kaste M, Fieschi C, von Kummer R, Davalos A, Meier D, Larrue V, Bluhmki E, Davis S, Donnan G, Schneider D, Diez-Tejedor E, Trouillas P (1998) 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. 352:1245–1251

    CAS  Google Scholar 

  22. Adams HP Jr, Bendixen BH, Kappelle LJ, Biller J, Love BB, Gordon DL, Marsh EE 3rd (1993) 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 24:35–41

    Article  PubMed  Google Scholar 

  23. Kim D, Ford GA, Kidwell CS, Starkman S, Vinuela F, Duckwiler GR, Jahan R, Saver JL, UCLA Intra-Arterial Thrombolysis Investigators (2007) Intra-arterial thrombolysis for acute stroke in patients 80 and older: a comparison of results in patients younger than 80 years. AJNR Am J Neuroradiol 28:159–163

    PubMed  CAS  Google Scholar 

  24. Pundik S, McWilliams-Dunnigan L, Blackham KL, Kirchner HL, Sundararajan S, Sunshine JL, Tarr RW, Selman WR, Landis DM, Suarez JI (2008) Older age does not increase risk of hemorrhagic complications after intravenous and/or intra-arterial thrombolysis for acute stroke. J Stroke Cerebrovasc Dis 17:266–272

    Article  PubMed  Google Scholar 

  25. Hacke W, Donnan G, Fieschi C, Kaste M, von Kummer R, Broderick JP, Brott T, Frankel M, Grotta JC, Haley EC Jr, Kwiatkowski T, Levine SR, Lewandowski C, Lu M, Lyden P, Marler JR, Patel S, Tilley BC, Albers G, Bluhmki E, Wilhelm M, Hamilton S, ATLANTIS Trials Investigators, ECASS Trials Investigators, NINDS rt-PA Study Group Investigators (2004) Association of outcome with early stroke treatment: pooled analysis of ATLANTIS, ECASS, and NINDS rt-PA stroke trials. Lancet 363:768–774

    Article  PubMed  Google Scholar 

  26. Hill MD, Buchan AM, Canadian Alteplase for Stroke Effectiveness Study (CASES) Investigators (2005) Thrombolysis for acute ischemic stroke: results of the Canadian Alteplase for Stroke Effectiveness Study. CMAJ 172:1307–1312

    Article  PubMed  Google Scholar 

  27. Wahlgren N, Ahmed N, Dávalos A, Hacke W, Millán M, Muir K, Roine RO, Toni D, Lees KR, SITS investigators (2008) Thrombolysis with alteplase 3–4.5 h after acute ischaemic stroke (SITS-ISTR): an observational study. Lancet 372:1303–1309

    Article  PubMed  CAS  Google Scholar 

  28. Boddu DB, Srinivasarao Bandaru VC, Reddy PG, Madhusudan M, Rukmini MK, Suryaprabha T, Jabeen SA, Suvarna A, Jayalakshmi SS, Meena AK, Borgohain R, Kaul S (2010) Predictors of major neurological improvement after intravenous thrombolysis in acute ischemic stroke: a hospital-based study from south India. Neurol India 58:403–406

    Article  PubMed  Google Scholar 

  29. Hemmen TM, Ernstrom K, Raman R (2011) Two-hour improvement of patients in the National Institute of Neurological Disorders and Stroke trials and prediction of final outcome. Stroke 42:3163–3167

    Article  PubMed  Google Scholar 

  30. Ntaios G, Faouzi M, Michel P (2011) The effect of thrombolysis on short-term improvement depends on initial stroke severity. J Neurol (Epub ahead of print)

  31. Sanossian N, Ovbiagele B (2009) Prevention and management of stroke in very elderly patients. Lancet Neurol 8:1031–1041

    Article  PubMed  Google Scholar 

  32. Optimising the Analysis of Stroke Trials (OAST) Collaboration, Gray LJ, Bath PM, Collier T (2009) Should stroke trials adjust functional outcome for baseline prognostic factors? Stroke 40:888–894

    Article  PubMed  Google Scholar 

  33. Kumar S, Selim MH, Caplan LR (2010) Medical complications after stroke. Lancet Neurol 9:105–118

    Article  PubMed  Google Scholar 

  34. Sandercock P, Lindley R, Wardlaw J, Dennis M, Lewis S, Venables G, Kobayashi A, Czlonkowska A, Berge E, Slot KB, Murray V, Peeters A, Hankey G, Matz K, Brainin M, Ricci S, Celani MG, Righetti E, Cantisani T, Gubitz G, Phillips S, Arauz A, Prasad K, Correia M, Lyrer P, IST-3 Collaborative Group (2008) Third international stroke trial (IST-3) of thrombolysis for acute ischaemic stroke. Trials 9:37

    Article  PubMed  Google Scholar 

  35. Lorenzano S, Toni D (2008) Intravenous thrombolysis with rt-PA in acute stroke patients aged >80 years: the TESPI study. Int J Stroke Suppl 1:135

    Google Scholar 

  36. The European Stroke Organization (ESO) Executive Committee and the ESO Writing Committee (2008) Guidelines for management of ischaemic stroke and transient ischaemic attack. Cerebrovasc Dis 25:457–507

    Article  Google Scholar 

Download references

Conflicts of interest

None.

Author information

Authors and Affiliations

  1. Neurology Department and Stroke Unit, Lille University Hospital, Hôpital Roger Salengro, 59037, Lille Cedex, France

    Gregoire Boulouis, Frederic Dumont, Charlotte Cordonnier, Marie Bodenant, Didier Leys & Hilde Hénon

Authors
  1. Gregoire Boulouis
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Frederic Dumont
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Charlotte Cordonnier
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Marie Bodenant
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Didier Leys
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Hilde Hénon
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Gregoire Boulouis.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Boulouis, G., Dumont, F., Cordonnier, C. et al. Intravenous thrombolysis for acute cerebral ischaemia in old stroke patients ≥80 years of age. J Neurol 259, 1461–1467 (2012). https://doi.org/10.1007/s00415-011-6359-4

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00415-011-6359-4

Keywords

Search

Navigation