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Experiences With Intravenous Thrombolysis in Acute Ischemic Stroke by Elderly Patients–A “Real World Scenario”
Objectives: This retrospective single-center study aimed to investigate the risk factors, outcomes and complication rates in patients older vs. younger than 80 years treated with intravenous alteplase. Methods: Data of 1,253 thrombolysed patients were analyzed between January 1, 2004 and August 31,...
Autores principales: | , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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Frontiers Media S.A.
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8473829/ https://www.ncbi.nlm.nih.gov/pubmed/34589048 http://dx.doi.org/10.3389/fneur.2021.721337 |
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author | Héja, Máté Fekete, István Horváth, László Márton, Sándor Fekete, Klára Edit |
author_facet | Héja, Máté Fekete, István Horváth, László Márton, Sándor Fekete, Klára Edit |
author_sort | Héja, Máté |
collection | PubMed |
description | Objectives: This retrospective single-center study aimed to investigate the risk factors, outcomes and complication rates in patients older vs. younger than 80 years treated with intravenous alteplase. Methods: Data of 1,253 thrombolysed patients were analyzed between January 1, 2004 and August 31, 2016. Vascular risk factors, stroke severity based on the NIHSS score, functional outcome using modified Rankin Scale (mRS), mortality and symptomatic intracerebral hemorrhage (SICH) were compared between two subgroups (<80 and ≥80 years). Results: 1,125 patients were included, 199 (17.6%) among them were aged over 80 years, majority (63.3%) were female (p < 0.00001). Mean age was 68.2 ± 12.4 years, i.e., 64.7 ± 10.8 years and 84.3 ± 3.4 years in the younger and the older groups, respectively (p < 0.001). Atrial fibrillation and pre-stroke anticoagulation among patients over 80 years was more likely (p < 0.0005 and p = 0.02, respectively). NIHSS scores on admission and at 24 h were higher in elderly patients (p < 0.0001). ASPECT score at 24 h was less favorable in elderly patients (p = 0.007) and was associated with worse outcome. At 3 months, 59.8% of the patients from the older group had an unfavorable outcome (p < 0.0001), however 34.7% had independent outcome. The one-year- survival was significantly worse in the older group (p < 0.0001). The incidence of SICH was lower among older patients. In a logistic regression model, atrial fibrillation, heart failure, diabetes mellitus and smoking were proven as a significant independent risk factors for worse outcome. Conclusion: Although, the outcomes were less favorable in patients over 80 years of age, our results support the feasibility of using intravenous thrombolysis among patients over 80 years of age. |
format | Online Article Text |
id | pubmed-8473829 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Frontiers Media S.A. |
record_format | MEDLINE/PubMed |
spelling | pubmed-84738292021-09-28 Experiences With Intravenous Thrombolysis in Acute Ischemic Stroke by Elderly Patients–A “Real World Scenario” Héja, Máté Fekete, István Horváth, László Márton, Sándor Fekete, Klára Edit Front Neurol Neurology Objectives: This retrospective single-center study aimed to investigate the risk factors, outcomes and complication rates in patients older vs. younger than 80 years treated with intravenous alteplase. Methods: Data of 1,253 thrombolysed patients were analyzed between January 1, 2004 and August 31, 2016. Vascular risk factors, stroke severity based on the NIHSS score, functional outcome using modified Rankin Scale (mRS), mortality and symptomatic intracerebral hemorrhage (SICH) were compared between two subgroups (<80 and ≥80 years). Results: 1,125 patients were included, 199 (17.6%) among them were aged over 80 years, majority (63.3%) were female (p < 0.00001). Mean age was 68.2 ± 12.4 years, i.e., 64.7 ± 10.8 years and 84.3 ± 3.4 years in the younger and the older groups, respectively (p < 0.001). Atrial fibrillation and pre-stroke anticoagulation among patients over 80 years was more likely (p < 0.0005 and p = 0.02, respectively). NIHSS scores on admission and at 24 h were higher in elderly patients (p < 0.0001). ASPECT score at 24 h was less favorable in elderly patients (p = 0.007) and was associated with worse outcome. At 3 months, 59.8% of the patients from the older group had an unfavorable outcome (p < 0.0001), however 34.7% had independent outcome. The one-year- survival was significantly worse in the older group (p < 0.0001). The incidence of SICH was lower among older patients. In a logistic regression model, atrial fibrillation, heart failure, diabetes mellitus and smoking were proven as a significant independent risk factors for worse outcome. Conclusion: Although, the outcomes were less favorable in patients over 80 years of age, our results support the feasibility of using intravenous thrombolysis among patients over 80 years of age. Frontiers Media S.A. 2021-09-13 /pmc/articles/PMC8473829/ /pubmed/34589048 http://dx.doi.org/10.3389/fneur.2021.721337 Text en Copyright © 2021 Héja, Fekete, Horváth, Márton and Fekete. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. |
spellingShingle | Neurology Héja, Máté Fekete, István Horváth, László Márton, Sándor Fekete, Klára Edit Experiences With Intravenous Thrombolysis in Acute Ischemic Stroke by Elderly Patients–A “Real World Scenario” |
title | Experiences With Intravenous Thrombolysis in Acute Ischemic Stroke by Elderly Patients–A “Real World Scenario” |
title_full | Experiences With Intravenous Thrombolysis in Acute Ischemic Stroke by Elderly Patients–A “Real World Scenario” |
title_fullStr | Experiences With Intravenous Thrombolysis in Acute Ischemic Stroke by Elderly Patients–A “Real World Scenario” |
title_full_unstemmed | Experiences With Intravenous Thrombolysis in Acute Ischemic Stroke by Elderly Patients–A “Real World Scenario” |
title_short | Experiences With Intravenous Thrombolysis in Acute Ischemic Stroke by Elderly Patients–A “Real World Scenario” |
title_sort | experiences with intravenous thrombolysis in acute ischemic stroke by elderly patients–a “real world scenario” |
topic | Neurology |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8473829/ https://www.ncbi.nlm.nih.gov/pubmed/34589048 http://dx.doi.org/10.3389/fneur.2021.721337 |
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