Thrombolysis for stroke in elderly in the late window period

Abstract

Objectives

Safety of intravenous thrombolysis (IVT) within 3–4.5 hours of stroke onset in patients ≥80 years is still disputable. We evaluated the association of symptom onset-to-treatment time (SOTT) with the symptomatic intracranial hemorrhage (sICH), poor outcome, and mortality in patients≥80 years.

Materials and Methods

In a retrospective study, patients treated with IVT following stroke were registered. Outcomes were poor outcome (mRS>2), sICH/ECASS-2, and in-hospital mortality. We compared the patients≥80 years who received IVT within 3 hours with those receiving IVT within 3–4.5 hours. We further compared the patients who were <80 years with those ≥80 years and SOTT of 3–4.5 hours.

Results

Of 834 patients, 265 aged over 80. In those above 80 and in multivariable analysis, the associations of SOTT with poor outcome (aOR: 1.401, CI: 0.503–3.903, p=0.519), sICH (aOR=2.50, CI=0.76–8.26, p= 0.132) and mortality (aOR=1.12, CI=0.39–3.25, p= 0.833) were not significant. 106 patients received IVT within 3–4.5 hours. In multivariable analysis, the associations of age (≥80 versus <80) with poor outcome (aOR=1.87, CI=0.65–5.37, p=0.246), sICH (aOR=0.65, CI=0.14–3.11, p=0.590), and mortality (aOR=0.87, 95% CI=0.16–4.57, p=0.867) were not significant in patients with SOTT of 3–4.5 hours.

Conclusion

IVT within 3–4.5 hours in patients ≥80 years is not associated with increased sICH, poor outcome, and mortality compared to the early time window, and also compared to the younger patients in 3–4.5 hours window period. The decision of IVT administration in this age group should not be made solely on the basis of stroke onset timing.

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