TY - JOUR
T1 - Intravenous Thrombolysis in Patients With Ischemic Stroke Aged ≥90 Years
T2 - A Cohort Study From the TRISP Collaboration
AU - Altersberger, Valerian L.
AU - Rusche, Norman
AU - Martinez-Majander, Nicolas
AU - Hametner, Christian
AU - Scheitz, Jan F.
AU - Henon, Hilde
AU - Dell'acqua, Maria Luisa
AU - Strambo, Davide
AU - Stolp, Jeffrey
AU - Heldner, Mirjam R.
AU - Grisendi, Ilaria
AU - Jovanovic, Dejana R.
AU - Bejot, Yannick
AU - Pezzini, Alessandro
AU - Leker, Ronen R.
AU - Kägi, Georg
AU - Wegener, Susanne
AU - Cereda, Carlo W.
AU - Thrombolysis in Stroke Patients (TRISP) collaborators
AU - Lindgren, Erik
AU - Ntaios, George
AU - Piot, Ines
AU - Polymeris, Alexandros A.
AU - Lyrer, Philippe A.
AU - Räty, Silja
AU - Sibolt, Gerli
AU - Tiainen, Marjaana
AU - Heyse, Miriam
AU - Erdur, Hebun
AU - Kaaouana, Olfa
AU - Padjen, Visnja
AU - Zedde, Marialuisa
AU - Arnold, Marcel
AU - Nederkoorn, Paul J.
AU - Michel, Patrik
AU - Bigliardi, Guido
AU - Zini, Andrea
AU - Cordonnier, Charlotte
AU - Nolte, Christian H.
AU - Ringleb, Peter A.
AU - Curtze, Sami
AU - Engelter, Stefan T.
AU - Gensicke, Henrik
N1 - Publisher Copyright: © 2022 American Heart Association, Inc.
PY - 2022/12/1
Y1 - 2022/12/1
N2 - 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.
AB - 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.
KW - aged
KW - intracranial hemorrhage
KW - ischemic stroke
KW - registries
KW - survivors
UR - http://www.scopus.com/inward/record.url?scp=85142940947&partnerID=8YFLogxK
U2 - https://doi.org/10.1161/STROKEAHA.122.039426
DO - https://doi.org/10.1161/STROKEAHA.122.039426
M3 - Article
C2 - 36252105
SN - 0039-2499
VL - 53
SP - 3557
EP - 3563
JO - Stroke
JF - Stroke
IS - 12
ER -