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J Stroke. 2015 Sep;17(3):327-35. doi: 10.5853/jos.2015.17.3.327. Epub 2015 Sep 30.

Intravenous Tissue Plasminogen Activator Improves the Outcome in Very Elderly Korean Patients with Acute Ischemic Stroke.

Author information

1
Department of Neurology, Jeju National University, Jeju, Korea.
2
Clinical Research Center, Asan Medical Center, Seoul, Korea.
3
Department of Neurology, Seoul Medical Center, Seoul, Korea.
4
Department of Neurology, Ilsan Paik Hospital, Inje University, Goyang, Korea.
5
Department of Neurology, Eulji General Hospital, Eulji University, Seoul, Korea.
6
Department of Neurology, Soonchunhyang University College of Medicine, Seoul, Korea.
7
Department of Neurology, Eulji University Hospital, Daejeon, Korea.
8
Department of Neurology, Yeungnam University Hospital, Daegu, Korea.
9
Department of Neurology, Chonnam National University Hospital, Gwangju, Korea.
10
Department of Neurology, Hallym University Sacred Heart Hospital, Anyang, Korea.
11
Department of Neurology, Dong-A University College of Medicine, Busan, Korea.
12
Department of Neurology, Dongguk University Ilsan Hospital, Goyang, Korea.
13
Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.
14
Department of Neurology, Ulsan University Hospital, Ulsan, Korea.
15
Department of Neurology, Chungbuk National University Hospital, Cheongju, Korea.
16
Department of Neurology, Keimyung University Dongsan Medical Center, Daegu, Korea.
17
Department of Biostatistics, Korea University College of Medicine, Seoul, Korea.

Abstract

BACKGROUND AND PURPOSE:

In a recent pooled analysis of randomized clinical trials (RCTs), intravenous tissue plasminogen activator (TPA) improves the outcome in patients aged ≥80 years. However, it is uncertain whether the findings are applicable to clinical practice in Asian populations.

METHODS:

From a multicenter stroke registry database of Korea, we identified patients with acute ischemic stroke who were aged ≥ 80 years. Using multivariable analysis and propensity score (PS)-matched analyses, we assessed the effectiveness and safety of intravenous TPA within 4.5 hours.

RESULTS:

Among 2,334 patients who met the eligible criteria, 236 were treated with intravenous TPA (mean age, 83±5; median NIHSS, 13 [IQR, 8-17]). At discharge, the TPA group compared to the no-TPA group had a favorable shift on the modified Rankin Scale (mRS) score (multivariable analysis, OR [95% CI], 1.51 [1.17-1.96], P=0.002; PS-matched analysis, 1.54 [1.17-2.04], P=0.002) and was more likely to achieve mRS 0-1 outcome (multivariable analysis, 2.00 [1.32-3.03], P=0.001; PS-matched analysis, 1.59 [1.04-2.42], P=0.032). TPA treatment was associated with an increased risk of symptomatic intracranial hemorrhage (multivariable analysis, 5.45 [2.80-10.59], P<0.001; PS-matched analysis, 4.52 [2.24-9.13], P<0.001), but did not increase the in-hospital mortality (multivariable analysis, 0.86 [0.50-1.48], P=0.58; PS-matched analysis, 0.88 [0.52-1.47], P=0.61).

CONCLUSIONS:

In the setting of clinical practice, intravenous TPA within 4.5 hours improved the functional outcome despite an increased risk of symptomatic intracranial hemorrhage in very elderly Korean patients. The findings, consistent with those from pooled analysis of RCTs, strongly support the use of TPA for this population.

KEYWORDS:

Elderly; Ischemic stroke; Outcome assessment; Thrombolytic therapy

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