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Too old to thrombolyse?

Correspondence to:
Correspondence to:
P C A J Vroomen
Department of Neurology, University Medical Center Groningen, Hanzeplein 1, PO Box 30001, 9700 RB Groningen, The Netherlands; c.a.j.vroomen@neuro.azg.nl

The first 150 words of the full text of this article appear below.

With the ageing of Western society, the absolute number of strokes occurring is likely to increase and the proportion of very old patients is sure to become greater.¹ This poses a double challenge: it will not only test the capacity of Western healthcare but also leave an increasing part of stroke management outside the comfortable confines of evidence-based medicine because younger patients tend to be included in stroke trials. Generalising the results of these trials to elderly people may cause problems for several reasons. The cardiac literature suggests that the rate of haemorrhagic complications associated with thrombolysis may increase with age.² No clear evidence, however, indicates that the rate of reperfusion is decreased in very old people. Also, when the natural course of strokes is less favourable in elderly people, this may be especially pronounced in the group without reperfusion—a strong argument for thrombolysis. Without sufficient trial . . . [Full text of this article]

Relevant Article

Thrombolysis in patients older than 80 years with acute ischaemic stroke: Canadian Alteplase for Stroke Effectiveness Study

P N Sylaja, Robert Cote, Alastair M Buchan, Michael D Hill on behalf of Canadian Alteplase for Stroke Effectiveness Study (CASES) Investigators
J. Neurol. Neurosurg. Psychiatry 2006 77: 826-829. [Abstract] [Full Text] [PDF]