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Intravenous Thrombolysis in Patients With Ischemic Stroke Aged ≥90 Years: A Cohort Study From the TRISP Collaboration.
Altersberger, Valerian L; Rusche, Norman; Martinez-Majander, Nicolas; Hametner, Christian; Scheitz, Jan F; Henon, Hilde; Dell'Acqua, Maria Luisa; Strambo, Davide; Stolp, Jeffrey; Heldner, Mirjam R; Grisendi, Ilaria; Jovanovic, Dejana R; Bejot, Yannick; Pezzini, Alessandro; Leker, Ronen R; Kägi, Georg; Wegener, Susanne; Cereda, Carlo W; Lindgren, Erik; Ntaios, George; Piot, Ines; Polymeris, Alexandros A; Lyrer, Philippe A; Räty, Silja; Sibolt, Gerli; Tiainen, Marjaana; Heyse, Miriam; Erdur, Hebun; Kaaouana, Olfa; Padjen, Visnja; Zedde, Marialuisa; Arnold, Marcel; Nederkoorn, Paul J; Michel, Patrik; Bigliardi, Guido; Zini, Andrea; Cordonnier, Charlotte; Nolte, Christian H; Ringleb, Peter A; Curtze, Sami; Engelter, Stefan T; Gensicke, Henrik.
  • Altersberger VL; Stroke Center and Department of Neurology, University Hospital Basel and University of Basel, Switzerland (V.L.A., N.R., I.P., A.A.P., P.A.L., S.T.E., H.G.).
  • Rusche N; Stroke Center and Department of Neurology, University Hospital Basel and University of Basel, Switzerland (V.L.A., N.R., I.P., A.A.P., P.A.L., S.T.E., H.G.).
  • Martinez-Majander N; Neurology and Neurorehabilitation, University Department of Geriatric Medicine FELIX PLATTER, University of Basel, Switzerland (N.R., S.T.E., H.G.).
  • Hametner C; Neurology, University of Helsinki and Helsinki University Hospital, Finland (N.M.-M., S.R., G.S., M.T., S.C.).
  • Scheitz JF; Department of Neurology, University Hospital Heidelberg, Germany C.H., M.H., P.A.R.).
  • Henon H; Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Klinik und Hochschulambulanz für Neurologie, Center for Stroke Research Berlin (CSB), Charité - Universitätsmedizin Berlin, Berlin Institute of Health at Charité - Universitätsmediz
  • Dell'Acqua ML; Univ. Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, F-59000 Lille, France (H.H., O.K., C.C.).
  • Strambo D; Neurology - Stroke Unit, Department of Neuroscience, Ospedale Civile di Baggiovara, Modena University Hospital, Italy (M.L.D.A., G.B.).
  • Stolp J; Stroke Center, Neurology Service, Lausanne University Hospital and University of Lausanne, Switzerland (D.S., P.M.).
  • Heldner MR; Amsterdam UMC location University of Amsterdam, Department of Neurology, the Netherlands (J.S., P.J.N.).
  • Grisendi I; Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Switzerland (M.R.H., G.K., M.A.).
  • Jovanovic DR; Neurology Unit-Stroke Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Italy (I.G., M.Z.).
  • Bejot Y; University of Belgrade, Faculty of Medicine, Neurology Clinic, University Clinical Centre of Serbia (D.R.J., V.P.).
  • Pezzini A; Department of Neurology, University Hospital Dijon, France (Y.B.).
  • Leker RR; Department of Clinical and Experimental Sciences, Neurology Clinic, University of Brescia, Italy (A.P.).
  • Kägi G; Department of Neurology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel (R.R.L.).
  • Wegener S; Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Switzerland (M.R.H., G.K., M.A.).
  • Cereda CW; Department of Neurology, Kantonsspital St. Gallen, Switzerland (G.K.).
  • Lindgren E; Department of Neurology, University Hospital Zurich and University of Zurich, Switzerland (S.W.).
  • Ntaios G; Stroke Center EOC, Neurology, Neurocenter of Southern Switzerland, EOC, Lugano, Switzerland (C.W.C.).
  • Piot I; Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg; Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden (E.L.).
  • Polymeris AA; Department of Internal Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece (G.N.).
  • Lyrer PA; Stroke Center and Department of Neurology, University Hospital Basel and University of Basel, Switzerland (V.L.A., N.R., I.P., A.A.P., P.A.L., S.T.E., H.G.).
  • Räty S; Stroke Center and Department of Neurology, University Hospital Basel and University of Basel, Switzerland (V.L.A., N.R., I.P., A.A.P., P.A.L., S.T.E., H.G.).
  • Sibolt G; Stroke Center and Department of Neurology, University Hospital Basel and University of Basel, Switzerland (V.L.A., N.R., I.P., A.A.P., P.A.L., S.T.E., H.G.).
  • Tiainen M; Neurology, University of Helsinki and Helsinki University Hospital, Finland (N.M.-M., S.R., G.S., M.T., S.C.).
  • Heyse M; Neurology, University of Helsinki and Helsinki University Hospital, Finland (N.M.-M., S.R., G.S., M.T., S.C.).
  • Erdur H; Neurology, University of Helsinki and Helsinki University Hospital, Finland (N.M.-M., S.R., G.S., M.T., S.C.).
  • Kaaouana O; Department of Neurology, University Hospital Heidelberg, Germany C.H., M.H., P.A.R.).
  • Padjen V; Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Klinik und Hochschulambulanz für Neurologie, Center for Stroke Research Berlin (CSB), Charité - Universitätsmedizin Berlin, Berlin Institute of Health at Charité - Universitätsmediz
  • Zedde M; Univ. Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, F-59000 Lille, France (H.H., O.K., C.C.).
  • Arnold M; University of Belgrade, Faculty of Medicine, Neurology Clinic, University Clinical Centre of Serbia (D.R.J., V.P.).
  • Nederkoorn PJ; Neurology Unit-Stroke Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Italy (I.G., M.Z.).
  • Michel P; Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Switzerland (M.R.H., G.K., M.A.).
  • Bigliardi G; Amsterdam UMC location University of Amsterdam, Department of Neurology, the Netherlands (J.S., P.J.N.).
  • Zini A; Stroke Center, Neurology Service, Lausanne University Hospital and University of Lausanne, Switzerland (D.S., P.M.).
  • Cordonnier C; Neurology - Stroke Unit, Department of Neuroscience, Ospedale Civile di Baggiovara, Modena University Hospital, Italy (M.L.D.A., G.B.).
  • Nolte CH; IRCCS Istituto delle Scienze Neurologiche di Bologna, Department of Neurology and Stroke Center, Maggiore Hospital, Bologna, Italy (A.Z.).
  • Ringleb PA; Univ. Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, F-59000 Lille, France (H.H., O.K., C.C.).
  • Curtze S; Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Klinik und Hochschulambulanz für Neurologie, Center for Stroke Research Berlin (CSB), Charité - Universitätsmedizin Berlin, Berlin Institute of Health at Charité - Universitätsmediz
  • Engelter ST; Department of Neurology, University Hospital Heidelberg, Germany C.H., M.H., P.A.R.).
  • Gensicke H; Neurology, University of Helsinki and Helsinki University Hospital, Finland (N.M.-M., S.R., G.S., M.T., S.C.).
Stroke ; 53(12): 3557-3563, 2022 12.
Article en En | MEDLINE | ID: mdl-36252105
ABSTRACT

BACKGROUND:

The probability to receive intravenous thrombolysis (IVT) for treatment of acute ischemic stroke declines with increasing age and is consequently the lowest in very elderly patients. Safety concerns likely influence individual IVT treatment decisions. Using data from a large IVT registry, we aimed to provide more evidence on safety of IVT in the very elderly.

METHODS:

In this prospective multicenter study from the TRISP (Thrombolysis in Ischemic Stroke Patients) registry, we compared patients ≥90 years with those <90 years using symptomatic intracranial hemorrhage (ECASS [European Cooperative Acute Stroke Study]-II criteria), death, and poor functional outcome in survivors (modified Rankin Scale score 3-5 for patients with prestroke modified Rankin Scale score ≤2 and modified Rankin Scale score 4-5 for patients prestroke modified Rankin Scale ≥3) at 3 months as outcomes. We calculated adjusted odds ratio with 95% CI using logistic regression models.

RESULTS:

Of 16 974 eligible patients, 976 (5.7%) were ≥90 years. Patients ≥90 years had higher median National Institutes of Health Stroke Scale on admission (12 versus 8) and were more often dependent prior to the index stroke (prestroke modified Rankin Scale score of ≥3; 45.2% versus 7.4%). Occurrence of symptomatic intracranial hemorrhage (5.7% versus 4.4%, odds ratioadjusted 1.14 [0.83-1.57]) did not differ significantly between both groups. However, the probability of death (odds ratioadjusted 3.77 [3.14-4.53]) and poor functional outcome (odds ratioadjusted 2.63 [2.13-3.25]) was higher in patients aged ≥90 years. Results for the sample of centenarians (n=21) were similar.

CONCLUSIONS:

The probability of symptomatic intracranial hemorrhage after IVT in very elderly patients with stroke did not exceed that of their younger counterparts. The higher probability of death and poor functional outcome during follow-up in the very elderly seems not to be related to IVT treatment. Very high age itself should not be a reason to withhold IVT.
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Texto completo: 1 Banco de datos: MEDLINE Asunto principal: Isquemia Encefálica / Accidente Cerebrovascular / Accidente Cerebrovascular Isquémico Tipo de estudio: Clinical_trials / Etiology_studies / Incidence_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Aged / Aged80 / Humans Idioma: En Año: 2022 Tipo del documento: Article
Texto completo
Imprimir
XML
PubMed Links
Search on Google

Texto completo: 1 Banco de datos: MEDLINE Asunto principal: Isquemia Encefálica / Accidente Cerebrovascular / Accidente Cerebrovascular Isquémico Tipo de estudio: Clinical_trials / Etiology_studies / Incidence_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Aged / Aged80 / Humans Idioma: En Año: 2022 Tipo del documento: Article