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Geriatr Gerontol Int. 2014 Oct;14(4):954-9. doi: 10.1111/ggi.12205. Epub 2013 Dec 9.

Thrombolytic therapy with intravenous recombinant tissue plasminogen activator in Japanese older patients with acute ischemic stroke: Fukuoka Stroke Registry.

Author information

1
Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.

Abstract

AIM:

The present study aimed to determine the efficacy and safety of thrombolytic therapy with recombinant tissue plasminogen activator (rt-PA) therapy in older patients compared with younger patients.

METHODS:

Using the Fukuoka Stroke Registry, a prospective multicenter study for acute stroke in Japan, we analyzed data of 401 patients with acute ischemic stroke (aged 74.5 ± 13.1 years) treated with thrombolytic therapy using rt-PA. Patients were categorized into two groups according to age: those aged ≥ 75 years (n=240) and <75 years (n=161). Neurological improvement was defined as a decrease in the National Institute of Health Stroke Scale (NIHSS) score of ≥ 4 during hospitalization or an NIHSS score of 0 at discharge. Good functional outcome was defined as a modified Rankin scale score of 0-2 at 3 months after onset.

RESULTS:

Neurological symptoms at admission were more severe in older patients than in younger patients. Old age (≥ 75 years) was not associated with neurological deterioration (multivariate-adjusted odds ratio [OR] 0.90, 95% confidence interval [CI] 0.46-1.77), neurological improvement (multivariate-adjusted OR 0.91, 95% CI 0.54-1.53) and symptomatic intracranial hemorrhage (multivariate-adjusted OR 1.11, 95% CI 0.19-8.87). Old age was negatively associated with good functional outcome (multivariate-adjusted OR 0.29, 95% CI 0.16-0.52) and positively associated with in-hospital mortality (multivariate-adjusted OR 19.3, 95% CI 2.4-474.9).

CONCLUSIONS:

In patients treated with rt-PA, old age is associated with poor functional outcome and in-hospital mortality. However, the probability of neurological improvement and symptomatic intracranial hemorrhage in older patients is comparable with that in younger patients.

KEYWORDS:

aged; brain infarction; functional outcome; thrombolysis; tissue plasminogen activator

PMID:
24320947
DOI:
10.1111/ggi.12205
[Indexed for MEDLINE]

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