Comparison of acute nonthrombolytic and thrombolytic treatments in ischemic stroke patients 80 years or older

Abstract Objectives The aim of this study was to compare the clinical outcomes of acute ischemic stroke patients 80 years or older treated with intravenous recombinant tissue plasminogen activator (IV rt-PA), or endovascular intervention with or without IV rt-PA, or nonthrombolytic medical treatment...

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Bibliographic Details
Published in:The American journal of emergency medicine 2012, Vol.30 (1), p.158-164
Main Authors: Zacharatos, Haralabos, DO, Hassan, Ameer E., DO, Vazquez, Gabriela, PhD, Hussein, Haitham M., MD, Rodriguez, Gustavo J., MD, Suri, M. Fareed K., MD, Lakshminarayan, Kamakshi, MD, PhD, Ezzeddine, Mustapha A., MD, Qureshi, Adnan I., MD
Format: Article
Language:English
Subjects:
Aged, 80 and over
Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy
Biological and medical sciences
Brain Infarction - drug therapy
Brain Infarction - surgery
Brain Infarction - therapy
Cardiovascular disease
Chi-Square Distribution
Emergency
Emergency medical care
Endovascular Procedures
Female
Fibrinolytic Agents - therapeutic use
Humans
Intensive care medicine
Logistic Models
Male
Medical imaging
Medical sciences
Mortality
Neurology
Recombinant Proteins - therapeutic use
Retrospective Studies
Stroke
Thrombolytic Therapy
Tissue Plasminogen Activator - therapeutic use
Treatment Outcome
Vascular diseases and vascular malformations of the nervous system
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Summary:Abstract Objectives The aim of this study was to compare the clinical outcomes of acute ischemic stroke patients 80 years or older treated with intravenous recombinant tissue plasminogen activator (IV rt-PA), or endovascular intervention with or without IV rt-PA, or nonthrombolytic medical treatment. Methods This study was a retrospective, nonrandomized, observational study of patients, admitted within 9 hours of symptom onset, at 3 academic, university-affiliated hospitals. The main outcome measures were neurologic improvement , defined by improvement in National Institutes of Health Stroke Scale score at 7 days or discharge of 4 or more, or achieving a score of 0; symptomatic and asymptomatic intracerebral hemorrhage; favorable outcome (discharge modified Rankin score 0-2); and in-hospital mortality. Results A total of 44 patients received IV rt-PA, 46 received endovascular intervention with or without IV rt-PA, and 66 received nonthrombolytic medical treatment. IV rt-PA–treated patients had a significantly clinically higher chance of favorable outcome (odds ratio [OR], 5.6; 95% confidence interval [CI], 1.8-17.5), when compared with nonthrombolytic medical treatment. A significantly higher rate of neurologic improvement was observed among the IV rt-PA (7.2; 95% CI, 2.7-19.5) and endovascularly treated patients (5.8; 95% CI, 2-16.8) when compared with nonthrombolytic medical treatment. Conclusions A prominently higher rate of neurologic improvement and favorable clinical outcome was observed among acute ischemic stroke patients 80 years or older treated with IV rt-PA or endovascular intervention when compared with nonthrombolytic medical treatment, supporting the use of acute thrombolytic therapies in this patient population when contraindications are not present.
ISSN:0735-6757
1532-8171
DOI:10.1016/j.ajem.2010.11.019