Use and Outcomes of Intravenous Thrombolysis for Acute Ischemic Stroke in Patients ≥90 Years of Age

Well you better not have a stroke over the age of 90, you may not be treated as aggressively. 
http://stroke.ahajournals.org/content/47/9/2347.abstract

1. Rohan Arora, MD;
2. Elliott Salamon, DO;
3. Jeffrey M. Katz, MD;
4. Margueritte Cox, MSc, MGIST;
5. Jeffrey L. Saver, MD;
6. Deepak L. Bhatt, MD, MPH;
7. Gregg C. Fonarow, MD;
8. Eric D. Peterson, MD, MPH;
9. Eric E. Smith, MD, MPH;
10. Lee H. Schwamm, MD;
11. Ying Xian, MD;
12. Richard B. Libman, MD

+ Author Affiliations

1. From the Department of Neurology, Hofstra Northwell School of Medicine, Hempstead, NY (R.A., E.S., J.M.K., R.B.L); Outcomes Research and Assessment Group (M.C.), Division of Cardiology, Department of Medicine (E.D.P.), and Department of Neurology (Y.X.), Duke Clinical Research Institute, Durham, NC; Department of Neurology and Comprehensive Stroke Center, David Geffen School of Medicine (J.L.S.) and Division of Cardiology (G.C.F.), University of California, Los Angeles; Brigham and Women’s Heart and Vascular Center and Harvard Medical School, Boston, MA (D.L.B.); Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Alberta, Canada (E.E.S.); and Stroke Service, Department of Neurology, Massachusetts General Hospital, Boston (L.H.S.).

1. Correspondence to Jeffrey L. Saver, MD, Department of Neurology, UCLA Comprehensive Stroke Center, Geffen School of Medicine at UCLA, 710 Westwood, Plaza, Los Angeles, CA 90095. E-mail jsaver@mednet.ucla.edu

Abstract

Background and Purpose—Intravenous tissue-type plasminogen activator (tPA) is a proven treatment for acute ischemic stroke, but there has been limited evaluation among patients aged ≥90 years.

Methods—We analyzed data from the Get With The Guidelines–Stroke national quality improvement registry from January 2009 to April 2013. Frequency, determinants, and outcomes of tPA use were compared among patients aged ≥90 and 3 younger age groups (18–64, 65–79, and 80–89 years).

Results—Among 35 708 patients from 1178 sites who arrived within 2 hours of time last known well and received tPA, 2585 (7.2%) were ≥90 years. Compared with younger patients, the rate of tPA use among patients without a documented contraindication was lower among patients aged ≥90 years (67.4% versus 84.1% in 18–89-year olds; P<0.0001). Discharge outcomes among individuals aged ≥90 years included discharge to home or acute rehabilitation in 31.4%, independent ambulation at discharge in 13.4%, symptomatic hemorrhage in 6.1%, and in-hospital mortality or hospice discharge in 36.4%. On multivariable analysis, good functional outcomes generally occurred less often and mortality more often among patients aged ≥90 years. The risk of symptomatic hemorrhage was increased compared with patients <65 years but was not significantly different than the risk in 66- to 89-year olds.

Conclusions—The use of intravenous tPA among those aged ≥90 years is lower than in younger patients. When fibrinolytic therapy is used, the risk of symptomatic hemorrhage is not higher than in 66- to 89-year olds; however, mortality is higher and functional outcomes are lower.