Intravenous TPA for very old stroke patients

Chin I. Chen, Yasuyuki Iguchi, James C. Grotta, Zsolt Garami, Ken Uchino, Hashem Shaltoni, Andrei V. Alexandrov

Research output: Contribution to journalArticle

52 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)140-144
Number of pages5
JournalEuropean Neurology
Volume54
Issue number3
DOIs
StatePublished - Dec 1 2005
Externally publishedYes

Fingerprint

Stroke
Intracranial Hemorrhages
Skilled Nursing Facilities
Hospital Mortality
Needles
Rehabilitation
Safety
Mortality
Therapeutics

Keywords

  • Ischemic stroke
  • TPA
  • Transcranial Doppler

ASJC Scopus subject areas

  • Clinical Neurology

Cite this

Chen, C. I., Iguchi, Y., Grotta, J. C., Garami, Z., Uchino, K., Shaltoni, H., & Alexandrov, A. V. (2005). Intravenous TPA for very old stroke patients. European Neurology, 54(3), 140-144. https://doi.org/10.1159/000089086

Intravenous TPA for very old stroke patients. / Chen, Chin I.; Iguchi, Yasuyuki; Grotta, James C.; Garami, Zsolt; Uchino, Ken; Shaltoni, Hashem; Alexandrov, Andrei V.

In: European Neurology, Vol. 54, No. 3, 01.12.2005, p. 140-144.

Research output: Contribution to journalArticle

Chen, CI, Iguchi, Y, Grotta, JC, Garami, Z, Uchino, K, Shaltoni, H & Alexandrov, AV 2005, 'Intravenous TPA for very old stroke patients', European Neurology, vol. 54, no. 3, pp. 140-144. https://doi.org/10.1159/000089086
Chen CI, Iguchi Y, Grotta JC, Garami Z, Uchino K, Shaltoni H et al. Intravenous TPA for very old stroke patients. European Neurology. 2005 Dec 1;54(3):140-144. https://doi.org/10.1159/000089086
Chen, Chin I. ; Iguchi, Yasuyuki ; Grotta, James C. ; Garami, Zsolt ; Uchino, Ken ; Shaltoni, Hashem ; Alexandrov, Andrei V. / Intravenous TPA for very old stroke patients. In: European Neurology. 2005 ; Vol. 54, No. 3. pp. 140-144.
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AU - Shaltoni, Hashem

AU - Alexandrov, Andrei V.

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AB - 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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