Intravenous Thrombolysis in Patients With Ischemic Stroke Aged ≥90 Years: A Cohort Study From the TRISP Collaboration.

Altersberger, Valerian L; Rusche, Norman; Martinez-Majander, Nicolas; Hametner, Christian; Scheitz, Jan F; Henon, Hilde; Dell'Acqua, Maria Luisa; Strambo, Davide; Stolp, Jeffrey; Heldner, Mirjam R; Grisendi, Ilaria; Jovanovic, Dejana R; Bejot, Yannick; Pezzini, Alessandro; Leker, Ronen R; Kägi, Georg; Wegener, Susanne; Cereda, Carlo W; Lindgren, Erik; Ntaios, George; ... (2022). Intravenous Thrombolysis in Patients With Ischemic Stroke Aged ≥90 Years: A Cohort Study From the TRISP Collaboration. Stroke, 53(12), pp. 3557-3563. Lippincott Williams & Wilkins 10.1161/STROKEAHA.122.039426

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BACKGROUND

The probability to receive intravenous thrombolysis (IVT) for treatment of acute ischemic stroke declines with increasing age and is consequently the lowest in very elderly patients. Safety concerns likely influence individual IVT treatment decisions. Using data from a large IVT registry, we aimed to provide more evidence on safety of IVT in the very elderly.

METHODS

In this prospective multicenter study from the TRISP (Thrombolysis in Ischemic Stroke Patients) registry, we compared patients ≥90 years with those <90 years using symptomatic intracranial hemorrhage (ECASS [European Cooperative Acute Stroke Study]-II criteria), death, and poor functional outcome in survivors (modified Rankin Scale score 3-5 for patients with prestroke modified Rankin Scale score ≤2 and modified Rankin Scale score 4-5 for patients prestroke modified Rankin Scale ≥3) at 3 months as outcomes. We calculated adjusted odds ratio with 95% CI using logistic regression models.

RESULTS

Of 16 974 eligible patients, 976 (5.7%) were ≥90 years. Patients ≥90 years had higher median National Institutes of Health Stroke Scale on admission (12 versus 8) and were more often dependent prior to the index stroke (prestroke modified Rankin Scale score of ≥3; 45.2% versus 7.4%). Occurrence of symptomatic intracranial hemorrhage (5.7% versus 4.4%, odds ratioadjusted 1.14 [0.83-1.57]) did not differ significantly between both groups. However, the probability of death (odds ratioadjusted 3.77 [3.14-4.53]) and poor functional outcome (odds ratioadjusted 2.63 [2.13-3.25]) was higher in patients aged ≥90 years. Results for the sample of centenarians (n=21) were similar.

CONCLUSIONS

The probability of symptomatic intracranial hemorrhage after IVT in very elderly patients with stroke did not exceed that of their younger counterparts. The higher probability of death and poor functional outcome during follow-up in the very elderly seems not to be related to IVT treatment. Very high age itself should not be a reason to withhold IVT.

Item Type:	Journal Article (Original Article)
Division/Institute:	04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Neurology
UniBE Contributor:	Heldner, Mirjam Rachel, Kägi, Georg Heinrich, Arnold, Marcel
Subjects:	600 Technology > 610 Medicine & health 300 Social sciences, sociology & anthropology > 360 Social problems & social services
ISSN:	0039-2499
Publisher:	Lippincott Williams & Wilkins
Language:	English
Submitter:	Pubmed Import
Date Deposited:	18 Oct 2022 10:54
Last Modified:	05 Dec 2022 16:26
Publisher DOI:	10.1161/STROKEAHA.122.039426
PubMed ID:	36252105
Uncontrolled Keywords:	aged intracranial hemorrhage ischemic stroke registries survivors
URI:	https://boris.unibe.ch/id/eprint/173835