Abstract TP71: Efficacy Of Intravenous Thrombolysis With Tissue Plasminogen Activator In Elderly Patients- Fukuoka Stroke Registry (FSR)
Background and purposes: Intravenous thrombolysis with tissue plasminogen activator (tPA) is efficacious to improve clinical outcomes in patients with acute ischemic stroke. However, the benefit of its use for elderly patients remains unclear. The aim of this study is to elucidate the clinical outcomes before and after tPA era and the efficacy of tPA in Japanese elderly patients with acute ischemic stroke.
Methods: The Fukuoka Stroke Registry (FSR) is a multicenter, stroke registry in Japan. As of May 2012, 13,761 patients within 7 days after onset were registered in the database. Among them, the elderly patients (≥75 years old, n=1,645) within 3 hours after onset were categorized into two groups according to the era: from Jun 1999 to Sep 2005 before approval of usage of tPA in Japan (pre-tPA group, n=910) and after that from Oct 2005 to May 2012 (post-tPA group, n=735). Neurological severity was assessed by NIH stroke scale score (NIHSS). Clinical outcomes were assessed as follows: neurological improvement (decrease in NIHSS more than 4 during hospitalization or NIHSS 0 at discharge), favorable functional outcome (modified Rankin Scale 0-1 at discharge), and in-hospital mortality.
Results: Thirty % of the patients in post-tPA group were treated by t-PA. Neurological improvement (pre-tPA group 44% vs post-tPA group 52%, P<0.001) and favorable functional outcome at discharge (pre-tPA group 21% vs post-tPA group 26%, P<0.001) were significantly more prevalent in post-tPA group than in pre-tPA group. The prevalence of in-hospital mortality (pre-tPA group 13% vs post-tPA group 8%, P=0.005) was significantly higher in pre-tPA group. In multivariable logistic analysis adjusted for confounding variables, intravenous thrombolysis was independently associated with good outcomes: neurological improvement (OR 1.94, 95% CI 1.46-2.59, P<0.001), favorable outcome at discharge (OR 2.88, 95%CI 1.89-4.38, P<0.001), and in-hospital mortality (OR 0.44, 95% CI 0.27-0.69, P<0.001). There was no significant difference in hemorrhage complications between both groups.
Conclusions: Intravenous thrombolysis improves clinical outcomes in elderly patients with acute ischemic stroke. Elderly patients can be treated efficiently and safely with intravenous thrombolysis.
- © 2012 by American Heart Association, Inc.