Abstract T MP78: Use, Safety, and Outcomes of Intravenous Thrombolysis for Acute Ischemic Stroke in Nonagenarians
Background: Even though IV tPA is the most proven treatment for AIS, it has not been studied extensively in the oldest old population. We used data from Get With The Guidelines(GWTG) to determine the frequency of use, outcomes, and safety of IV tPA in AIS patients who are 90 and older.
Methods: The population consisted of 39,759 patients from 1178 sites who were eligible for IV tPA. who received IV tPA within 3 hours of symptom onset from January 2009 April 2013. Of these, 3,407 patients were 90 years and older. The patients who had contraindications to IV tPA were excluded and advanced age alone was not considered a sufficient contraindication for this study. The primary outcomes of interest were: in hospital mortality, discharge disposition, independent ambulation at discharge, sICH and complications related to IV tPA.The differences in baseline these characteristics were compared using chi-square tests for categorical row variables and Wilcoxon Rank-Sum tests for continuous row variables.Factors associated with tPA use in older patients were assessed using logistic regression with generalized estimating equations to account for within hospital correlations. Outcomes among patients receiving IV-tPA were also compared between old patients (90+) and the three younger age groups.
Results: With 90 and above as the reference group, the odds ratio for mortality adjusted to patient characteristics was 0.90 (CI- 0.78, 1.04) in the age group of 80-89. However, the adjusted OR for age group of 65-79 was 0.68 (CI 0.5, 0.79) and for 18-64 was 0.48 (0.40, 0.58)As compared to 90 and above, the patients in age group of 80-89 had 2.25 times the odds to be discharged to home or rehab and this trend was more pronounced in the lower age groups (5.5 times for age 65-79 and 14.7 times for age 18-64). The rates of sICH were 6.8 % in age group 80-89 and 6.1 % amongst the 90 and older, which, however, was significantly lower in age groups less than 65 (2.9%) and 65-79 (5.1%).
Conclusion: Advanced Age increases the likelihood of sICH but the rates of sICH were are still comparable to younger cohorts. The knowledge of high risk of mortality in this population may help real time bedside decision making while treating patients 90 and above.
Author Disclosures: R. Arora: None. E. Salamon: None. J.M. Katz: None. R.B. Libman: None.
- © 2015 by American Heart Association, Inc.