Abstract T P48: Intravenous Thrombolysis Using Low-Dose Alteplase for Nonagenarians with Acute Ischemic Stroke: The SAMURAI rtPA Registry
Objective: Although intravenous thrombolysis (IVT) using alteplase for octogenarians with acute ischemic stroke becomes relatively familiar, it is unclear whether IVT for nonagenarians is a futile intervention. The purpose of this study is to clarify the efficacy and safety of IVT using low-dose alteplase (0.6 mg/kg) for nonagenarians compared with octogenarians.
Methods: Stroke Acute Management with Urgent Risk-factor Assessment and Improvement (SAMURAI) rtPA registry retrospectively collected 600 consecutive acute stroke patients receiving IVT from 10 Japanese stroke centers between October 2005 and July 2008. We extracted all octogenarians (O group) and nonagenarians (N group) from the registry. We compared baseline characteristics, symptomatic intracranial hemorrhage (SICH), and 3-month outcomes between the groups. 3-month outcomes include; functional independence (FI) defined as a mRS score 0-2, good outcome (GO) as a mRS score 0-2 or same as the premorbid mRS, poor outcome (PO) defined as a mRS score 5-6, and death.
Results: Twenty-five nonagenarians (mean age, 93 years) and 124 octogenarians (mean age, 84 years) were included. N group was more female-predominant (76% versus 56%, p=0.06) and premorbidly dependent (44% versus 14%, p<0.001) than O group. There were no significant differences of median baseline NIHSS score (16 versus 14, p=0.95) and Alberta Stroke Program Early CT Score (9 versus 9, p=0.36) between the groups. The rate of FI tended to be lower in N group than O group (16% versus 36%, p=0.06), otherwise, the differences of the rates of GO (28% versus 37%, p=0.39), PO (40% versus 36%, p=0.73), death (20% versus 11%, p=0.23) and SICH (0% versus 2.4%, p=1.00) were not significant between the groups. In comparison with O group, N group was not associated with 3-month clinical outcomes (FI; OR 0.61; 95% CI, 0.15-2.42, GO; 0.98; 0.31-3.07, PO; 0.63; 0.15-2.70, death; 3.18; 0.62-16.3) and SICH (0.68; 0.17-2.69) after multivariate adjustment.
Conclusions: IVT using low-dose alteplase for N group resulted in less frequent achievement of FI mainly because of more premorbid dependency than O group, however, showed at least a similar safety and a potential efficacy.
Author Disclosures: M. Hayakawa: None. M. Koga: Honoraria; Modest; Kyowa Hakko Kirin Co., Ltd. S. Sato: None. S. Arihiro: None. Y. Shiokawa: None. J. Nakagawara: None. E. Furui: None. K. Kimura: Honoraria; Significant; Otsuka, Tanabemitsubishi, Boehringer Ingelheim. Y. Hasegawa: None. H. Yamagami: Research Grant; Modest; Japan Cardiovascular Research Foundation. Honoraria; Modest; Otsuka, Boehringer Ingelheim. Y. Okada: None. S. Okuda: None. K. Kario: None. K. Minematsu: Research Grant; Significant; Grants-in-Aid from the Ministry of Health, Labour and Welfare, Japan, Reserch Grants for Cardiovascular Disease from National Cerebral and Cardiovascular Center, Mihara Cerebrovascular Disorder Reserch Promotion Fund. Other Research Support; Modest; Tanabe-Mitsubishi Pharma, Kyowa Hakko Kirin Pharma, Lundbeck, Sanofi-Aventis, Century Medical, Hitachi Medical. Honoraria; Modest; Tanabe-Mitsubishi Pharma, Kyowa Hakko Kirin Pharma, Sanofi-Aventis, Otsuka Pharmaceutical, Bayer Healthcare, Asteras Pharma, Dai-ichi Sankyo, Kowa, Boehringer Ingelheim, Novartis. K. Toyoda: Research Grant; Significant; Grants-in-aid from the Ministry of Health, Labor and Welfare of Japan.
- © 2014 by American Heart Association, Inc.