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Thrombolysis in patients older than 80 years with acute ischaemic stroke: Canadian Alteplase for Stroke Effectiveness Study
  1. P N Sylaja1,
  2. Robert Cote2,
  3. Alastair M Buchan3,
  4. Michael D Hill1,
  5. on behalf of Canadian Alteplase for Stroke Effectiveness Study (CASES) Investigators
  1. 1Calgary Stroke Program, Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
  2. 2McGill University, Montreal General Hospital, Montreal, Québec, Canada
  3. 3Oxford University, Oxford, UK
  1. 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}


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.

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

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  • Published Online First 27 February 2006

  • Competing interests: None declared.

  • CASES writing committee—Chairs: Michael D Hill, Alastair M Buchan; Members: Stephen Phillips, , Richard Riopelle, Frank Silver, Daniel Selchen, Betty-Anne Schwarz, Vladimir Hachinski, Ashfaq Shuaib, Philip Teal. CASES investigators—Alberta: Alastair M Buchan (Co-principal investigator), Michael D Hill (Co-principal investigator), Andrew M Demchuk, Keith M Hoyte, Gary M Klein, Philip A Barber, Nancy Newcommon, Andrea Cole-Haskayne, Zeenie Ramji, Diana Czechowsky, William Ghali, Rollin Brant, JH Warwick Pexman, Ashfaq Shuaib, Edina Kadribasic, Toni Winder, Carolyn Walker, Prafull Parekh, Scott Wilson, Yolande Westra, Robert Burris, Gail Deagle, Laurel Reynolds; British Columbia: Philip Teal, Andrew Woolfenden, Claire Johnston, Todd Collier, Judy Moa, Donald Cameron, Loree Tadey, Cate Earl, Tracy Sacre, Kennely Ho, Frank Kemble, Elizabeth Mauthe, Lynda MacFarlane, David Novak, Richard Grosch, Joe Haegart, Cathy Metcalfe, Dr Milton Wong, Barbara Boychuk, Terry Curran, Suzanne Bailey, Anthony Costantino, Helen Costantino, David Craig, Michelle Mantle, Judith Huff, Michael Kenyon, Cutler, Chuck Mahoney, Jo Thoburn; Manitoba: Brian A Anderson, Mohammad Nagaria, Dan F Gladish, Brian Schmidt, Douglas Eggertson, Douglas Hobson, Lawrence Hudson, Greg McGinn, Farid Esfahani; New Brunswick: Peter Bailey, Gregg MacLean, A MacDougall, Peggy Cook, Shelly Alward, Mary Freeman-McCraek, Lynn Reid, Byrne Harper; Newfoundland: Alan Gooderidge, William Pryse-Phillips, Mark Stefanelli, Jim Scott; Nova Scotia: Stephen Phillips, Gordon Gubitz, Judith Jarrett, Richard Leckey, G Maharaj; Ontario: Rudolph Arts, Sylvia Styling, Vladimir Hachinski, J David Spence, Brian Silver, Bart M Demaerschalk, Ashok Devasenapathy, Jose G Merino, Edward H Wong, J Arturo Tamayo Mendoza, Blaine Foell, Fali Poncha, Connie A Frank, Mary M McTaggart, Frank Silver, Cheryl Jaigobin, Shelley Yantha, Pamela Urzua, Relu Wiegner, Bob Duke, Wes Oczkowski, David Fletcher, Sera Nicosia, Nancy Pyette, Sandy Black, Na Jiang, David Gladstone, Edwin Klimek, Chidambaram Yegappan, Marianne Klimek, Jeanine Robinson, Daniel Selchen, Alnoor Dhanani, Bryan Temple, Heather Hink, Deidre Davidson, Kathryn Leblanc, Suzanne Christie, Lucian Sitwell, Andre Douen, Antoine Hakim, Nicole Pageau, Hyman Rabinovitch, Martin Del Campo, Neville Bayer, David Morgenthau, Gabrielle De Veber, Andrew Kertesz, Darlyne Morlog, Richard Magder, Garry Moddel, Chidambaram Yegappan, Iram Zando, Martin Lees, Peter Stys, Betty Anne Schwarz, David Howse, Richard Riopelle, Cindy Bolton, Sandy Weatherby, Dianne Groll, Mukul Sharma, Hiren Desai, Michael Winger, Dave Tamblyn, Stephane Sauve, Hui Lee, Deon Leow, Dwight Stewart, Susan Fawcett, Vince dePaul; Quebec: Robert Cote, Liam Durcan, Anne-Marie Fontaine, Lisa Wadup, Francois Jacques, Denis Halle, André Bellavance, Leo Berger, Linda Moisan, Jeanne Teitelbaum, Nicole Lachance, Ariane Mackey, Denis Simard, Annette Hache, Barbara Léger, Lison Fournier, Sophie Dubé, Jeffrey Minuk, Louise-Hélène Lebrun, Andre Durocher, Nicole Daneault, Sylvain Lanthier, Marlene Lapierre, Marie-Paul Desrochers, Michel Beaudry, Doris Boivin, Donald Rivest, Marc Petitclerc, Marie Berberl, Charles Beaurivage, Albert Lamontagne, Serge Desviens; Saskatchewan: Ali Rajput, Christopher Voll, Michele Rajput, Aileen Schultz, Felix Veloso, Barbara Seal, L Moodley. CASES CT review group—JH Warwick Pexman, Philip A Barber, Andrew M Demchuk, Michael D Hill. C Hoffmann-La roche representatives—Alberta: Alanna Campbell, Frank Heron; British Columbia: Kath Davy; Manitoba/Saskatchewan: Kath Davy; Ontario: Angie McAllister; Quebec: Rene Garneau; Atlantic Canada: Linda Mosher. Administrative assistant: Vivian Thompson. Regional business manager: Jean-Rene Poirier. Associate medical directors: Kate Lawrence, Esther Tan. Director of marketing, hospital care: Alan LeVoguer. Canadian Stroke Network—President: Antoine Hakim. Heart & Stroke Foundation of Canada: Elinor Wilson. Canadian Stroke Consortium—President: Philip Teal; Past President: John Norris; Staff: Donna Huber.

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