(Stroke. 2000;31:370.)
© 2000 American Heart Association, Inc.
Original Contributions |
Intravenous Tissue Plasminogen Activator for Acute Ischemic Stroke in Patients Aged 80 Years and Older
The tPA Stroke Survey Experience
From the Departments of Neurology (D.T., M.J.G., S.R.L.) and Biostatistics and Research Epidemiology (L.R.S.), Henry Ford Health Science Center, Detroit, Mich; Department of Neurology, Dent Neurological Institute, Buffalo, NY (V.E.B.); Department of Neurology, University of Pennsylvania Medical Center, Philadelphia (S.E.K.); Department of Emergency Medicine, University of Michigan Medical Center, Ann Arbor (P.S.); Department of Neurology, Seton-Hall University, East Orange, NJ (P.V.); Department of Neurology, Medical College of Wisconsin, Milwaukee (J.R.B.); and Department of Neurology, Thomas Jefferson University Hospital, Philadelphia, Pa (J.M.D.).
Correspondence to David Tanne, MD, Stroke Unit, Department of Neurology, Chaim Sheba Medical Center, Tel Hashomer 52621, Israel. E-mail tanne{at}post.tau.ac.il
Background and
Purpose—Intravenous tissue
plasminogen activator (tPA) administered within
3 hours of symptom onset is the first available effective therapy for
acute ischemic stroke (AIS). Few data exist, however, on its
use in very elderly patients. We examined the characteristics,
complications, and short-term outcome of AIS patients aged 
80 years
treated with tPA.
Methods—Patients aged 80 years (n=30) were compared with
counterparts aged <80 years (n=159) included in the tPA Stroke Survey,
a US retrospective survey of 189 consecutive AIS patients treated with
intravenous tPA at 13 hospitals.
Results—Risk of intracerebral hemorrhage
(fatal, symptomatic, and total) was 3%, 3%, and 7% in
the elderly age group and 2%, 6%, and 9%, respectively, in their
younger counterparts (P=NS for all comparisons).
Likelihood of favorable outcome, defined as modified Rankin score 0 to
1, National Institutes of Health Stroke Scale score 
5, or marked
improvement by hospital discharge, was comparable between groups (37%,
54%, and 43% versus 30%, 54%, and 43%, respectively;
P=NS for all comparisons). Elderly patients were more
likely to be treated by stroke specialists (87% versus 60%;
P=0.005) and less likely to have an identified protocol
deviation (13% versus 33%; P=0.03). Elderly patients
were discharged more often to nursing care facilities (17% versus 5%;
P=0.003). In logistic regression models there were no
differences in odds ratio for favorable or poor outcome, other than
tendency for higher in-hospital mortality in elderly patients (odds
ratio, 2.8; 95% CI, 0.81 to 9.62; P=0.10).
Conclusions—Among AIS patients treated with
intravenous tPA, age-related differences in characteristics
and disposition were identified. No evidence for withholding tPA
treatment for AIS in appropriately selected patients aged 80 years
was identified.
Key Words: cerebral ischemia • elderly • stroke • thrombolytic therapy
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