Abstract NS25: Alteplase Administration in the Very Elder
Background /Purpose: The highest rate of first time strokes occurs in those 80 years and older. Despite the higher stroke rates, increased incidence of atrial fibrillation and often increased severity of stroke in the very elderly, initial clinical trials related to intravenous alteplase did not recruit patients over 80 years of age. Newer evidence supporting use of Alteplase in the very elder recommends that age alone should not be a contraindication for administering alteplase and urges that the risks and benefits be carefully weighed. Additional evidence concludes that although elderly patients have a higher mortality rate and poorer functional outcomes, this finding is consistent with the natural course of aging and treatment benefit may be realized. The purpose of this multihospital system retrospective review is to examine data in patients who received alteplase with the hypothesis that elders greater than 80 years benefited just as much from treatment when compared to those less than 80.
Methods: Retrospective data collected at a large Midwestern hospital system compared alteplase administration in patients greater than 80 years of age to patients less than 80. Data examined included initial NIHSS, symptomatic hemorrhage rates, discharge disposition, and incidence of atrial fibrillation.
Results: Comparisons (> 80 years vs. < 80 years) revealed: 1) 34% of patients treated with alteplase were greater than 80 years, 2) symptomatic hemorrhage rates were not statistically different (13% vs 8%, p=0.1904), 3) negative discharge outcomes (destination other than home or acute rehab) were more prevalent in the elder population (48% vs. 19%, p< .0001), 4) atrial fibrillation was more prevalent in elders (53%).
Conclusions: Despite newer evidence, reluctance among practitioners to administer alteplase to the very elderly persists. In very elderly patients, retrospective data findings indicated that hemorrhage rates were not increased but short-term discharge outcomes were negatively impacted. This may be the result of the aging process and multiple comorbidities. Evaluation and dissemination of findings will emphasize to providers that this vulnerable population may still benefit from alteplase treatment.
Author Disclosures: L. Klassman: None. P. Siegele: None. D. Behrens: None. J. Boerschinger: None. K. De Re: None. J. Fitzpatrick: None. D. Jenkins-West: None. M. Jennrich: None. M. Masor: None. K. Murczek: None. K. Peterson: None. J. Pouliot: None. V. Steinkoenig: None.
- © 2015 by American Heart Association, Inc.