Intravenous Thrombolysis with Neuroprotective Therapy by Edaravone for Ischemic Stroke Patients Older than 80 Years of Age

Background Alteplase, a recombinant tissue plasminogen activator (tPA), was approved for patients with acute ischemic stroke within 3 hours of stroke onset in Japan in October 2005 at a dose of 0.6 mg/kg. The aim of this study was to assess the safety and efficacy of alteplase in elderly patients in...

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Published in:Journal of stroke and cerebrovascular diseases 2013-10, Vol.22 (7), p.1175-1183
Main Authors: Kono, Syoichiro, MD, Deguchi, Kentaro, MD, Morimoto, Nobutoshi, MD, Kurata, Tomoko, MD, Yamashita, Toru, MD, PhD, Ikeda, Yoshio, MD, PhD, Narai, Hisashi, MD, PhD, Manabe, Yasuhiro, MD, PhD, Takao, Yoshiki, MD, PhD, Kawada, Sanami, MD, PhD, Kashihara, Kenichi, MD, PhD, Takehisa, Yasushi, MD, PhD, Inoue, Satoshi, MD, PhD, Kiriyama, Hideki, MD, PhD, Abe, Koji, MD, PhD
Format: Article
Language:English
Subjects:
Acute ischemic stroke
Adult
Aged
Aged, 80 and over
Antipyrine - administration & dosage
Antipyrine - analogs & derivatives
Antipyrine - therapeutic use
Brain Ischemia - drug therapy
Cardiovascular
edaravone
elderly
Female
Fibrinolytic Agents - administration & dosage
Fibrinolytic Agents - adverse effects
Fibrinolytic Agents - therapeutic use
Humans
intracerebral hemorrhage
Male
Middle Aged
Neurology
Neuroprotective Agents - administration & dosage
Neuroprotective Agents - therapeutic use
recanalization
Retrospective Studies
Stroke - drug therapy
Thrombolytic Therapy - adverse effects
Thrombolytic Therapy - methods
Time Factors
tissue plasminogen activator
Tissue Plasminogen Activator - administration & dosage
Tissue Plasminogen Activator - adverse effects
Tissue Plasminogen Activator - therapeutic use
Treatment Outcome
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Summary:Background Alteplase, a recombinant tissue plasminogen activator (tPA), was approved for patients with acute ischemic stroke within 3 hours of stroke onset in Japan in October 2005 at a dose of 0.6 mg/kg. The aim of this study was to assess the safety and efficacy of alteplase in elderly patients in Japan. Methods One hundred twenty-nine consecutive patients who were admitted to our 5 hospital groups and who received intravenous tPA within 3 hours of stroke onset between January 2010 and December 2011 were divided into 2 groups by age (80 years of age [older group]) and by treatment with or without edaravone. Clinical backgrounds and outcomes were investigated. Results The National Institutes of Health Stroke Scale score on admission was not different in both groups, but the National Institutes of Health Stroke Scale scores 7 days after stroke onset were significantly higher in the older group (score 8; P < .05) than in the younger group (score 4), and the ratio of patients with a modified Rankin Scale score of 4 to 6 was significantly greater in the older group (41.7%; P < .05) than in the younger group (22.2%). However, there was no difference in asymptomatic and symptomatic intracerebral hemorrhage rates between the younger and older groups (asymptomatic 20.2% v 18.8%; symptomatic 2.6% v 2.1%). Patients with edaravone showed a higher recanalization rate (61.9%; P < .01) and a better modified Rankin Scale score at 3 months poststroke ( P < .01) than the nonedaravone group. Conclusions These data suggest that intravenous alteplase (0.6 mg/kg) within 3 hours of stroke onset was safe and effective, even for very old patients (≥80 years of age), but resulted in poor outcomes relating not to tPA but to aging. In addition, edaravone may be a good partner for combination therapy with tPA to enhance recanalization and reduce hemorrhagic transformation.
ISSN:1052-3057
1532-8511
DOI:10.1016/j.jstrokecerebrovasdis.2013.02.010