PT  - JOURNAL ARTICLE
AU  - M S Mouradian
AU  - A Senthilselvan
AU  - G Jickling
AU  - J A McCombe
AU  - D J Emery
AU  - N Dean
AU  - A Shuaib
TI  - Intravenous rt-PA for acute stroke: comparing its effectiveness in younger and older patients
AID  - 10.1136/jnnp.2004.047803
DP  - 2005 Sep 01
TA  - Journal of Neurology, Neurosurgery & Psychiatry
PG  - 1234--1237
VI  - 76
IP  - 9
4099  - http://jnnp.bmj.com/content/76/9/1234.short
4100  - http://jnnp.bmj.com/content/76/9/1234.full
SO  - J Neurol Neurosurg Psychiatry2005 Sep 01; 76
AB  - Objective: To study the short and long term differences in outcome between patients ⩾80 years of age and those ⩽79 years of age who received intravenous recombinant tissue plasminogen activator (iv rt-PA) for acute stroke within the first 3 hours of symptom onset. Methods: We studied consecutive patients treated with iv rt-PA for acute stroke, with prospective follow up of up to 3 years. Outcome measures included National Institutes of Health Stroke Scale (NIHSS) score, Barthel Index (BI), modified Rankin score (MRS), and stroke mortality. Patients were split into two groups: younger (⩽79 years) and older (⩾80 years). Results: There were 65 patients in the younger cohort and 31 patients in the older. Older patients were more likely to present with more severe baseline stroke (p = 0.04; odds ratio (OR) 3.04; 95% confidence interval (CI) 1.03 to 8.98). Stroke mortality at 90 days was 10.8% in the younger and 32.3% in the older cohort (p = 0.01). At 90 days’ follow up, patients in the older cohort with more severe stroke (NIHSS score ⩾11) were nearly 10 times more likely to have poor outcome compared with their younger counterparts presenting with severe stroke (p = 0.001; OR = 10.36; 95% CI 2.16 to 49.20). Baseline stroke severity and age were the only independent and equal predictors for stroke outcome. No threshold was found for age or baseline stroke severity predicting outcome. Conclusion: Older patients presenting with more severe baseline stroke are much less likely to benefit from iv rt-PA as compared with their younger counterparts.