¹ Calgary Stroke Program, Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
² McGill University, Montreal General Hospital, Montreal, Québec, Canada
³ Oxford University, Oxford, UK

Correspondence to:
Correspondence to:
Associate Professor Dr Michael D Hill
Calgary Stroke Program, Department of Clinical Neurosciences, Foothills Hospital, Room 1242A, Calgary, AB T2N 2T9, Canada; michael.hill{at}calgaryhealthregion.ca

Background: The benefit of intravenous tissue plasminogen activator (tPA) given within 3 h of acute ischaemic stroke to patients over 80 years of age is uncertain.

Aim: To examine the clinical characteristics and complications and the predictors of outcome after intravenous tPA treatment in patients aged 80 years.

Methods: Data (n = 1135) prospectively collected from the Canadian Alteplase for Stroke Effectiveness Study were reviewed and patients aged 80 years (n = 270) treated with intravenous tPA for acute ischaemic stroke were compared with those aged <80 years (n = 865).

Results: The risk of symptomatic intracerebral haemorrhage did not differ between patients aged 80 years and <80 years (4.4% (95% CI 2.3 to 7.6) v 4.6% (95% CI 3.3 to 6.2), p = 1.0). Favourable outcome, defined as a modified Rankin Score of 0–1 at 90 days, was seen in 26% of patients aged 80 years and in 40% of those <80 (p<0.001). The following baseline characteristics were found to be more common in those aged 80 years than in those aged <80 years: atrial fibrillation (37% v 18%; p<0.001); congestive heart failure (11% v 6%; p = 0.004); hypertension (59% v 48%; p = 0.002); and severity of stroke with a median National Institutes of Health Stroke Scale (NIHSS) score of 16 v 14 (p = 0.004). In the multivariable logistic regression analysis, age 80 years, stroke severity, baseline Alberta Stroke Program Early CT Score and glucose level were found to be the major independent predictors of outcome.

Conclusion: In carefully selected elderly patients, the use of intravenous tPA was not found to be associated with an increased risk of symptomatic intracerebral haemorrhage. Age-related differences were seen in the clinical characteristics and outcome in the elderly population.

Abbreviations: CT, computed tomography; ICH, intracerebral haemorrhage; NIHSS, National Institutes of Health Stroke Scale; tPA, tissue plasminogen activator

Relevant Article

Too old to thrombolyse?

P C A J Vroomen
J. Neurol. Neurosurg. Psychiatry 2006 77: 812. [Extract] [Full Text] [PDF]

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