Abstract
Intravenous thrombolysis with alteplase within 4.5 hours from symptom onset is a well-established treatment of acute ischaemic stroke (AIS). The aim was to compare alteplase for AIS between patients aged >80 and ≤80 years in our registry data, from 2013 to 2018. Mechanical thrombectomy cases were excluded. We assessed clinical outcomes over the six-year period and between patients aged over 80 and ≤80 years, using measures including the discharge modified Rankin Scale (mRS), 24-hour National Institutes of Health Stroke Scale (NIHSS) improvement, and symptomatic intracerebral haemorrhage (sICH) rate. Of a total of 805 AIS patients who received intravenous alteplase, 278 (34.5%) were over 80 years old, and 527 (65%) were younger. 616 (76.5%) received thrombolysis ≤ 3 hours after symptom onset and 189 (23.5%) within 3-4.5 hours. Median baseline mRS and NIHSS of the elderly cohort were 1 (IQR 0-5) and 13 (IQR 2-37), respectively, compared to the younger cohort 0 (IQR 0-5) and 9 (IQR 0-29). The sICH rate was 7.2% in the elderly and 4.6% in those ≤80 years, p = 0.05. NIHSS improved within 24 hours in 34% of the elderly cohort compared to 35% in the younger cohort. At hospital discharge, the mortality rate was 9% in the elderly cohort compared to the 6% in the younger cohort, p = 0.154. 25% of patients aged >80 years had mRS ≤ 2 compared to 47% in the younger patients (p < 0.0001). In conclusion, thrombolysis in elderly patients results in clinical improvement comparable to younger patients.
Highlights
Intravenous (IV) thrombolysis is a well-established treatment for acute ischaemic stroke (AIS)
Thrombolysis for AIS up to 4.5 hours after onset became a common practice after the results of the European Cooperative Acute Stroke Study (ECASS) III trial were published in 2008 [2]
This is a retrospective study of our data entered prospectively in the UK Sentinel Stroke National Audit Programme (SSNAP) audit identifying all patients thrombolysed between January 2013 and December 2018
Summary
Intravenous (IV) thrombolysis is a well-established treatment for AIS. Thrombolysis for AIS up to 4.5 hours after onset became a common practice after the results of the European Cooperative Acute Stroke Study (ECASS) III trial were published in 2008 [2]. This study had stringent criteria, excluding patients aged over 80 years and those with a combination of previous stroke and diabetes mellitus. Evidence emerged that treating patients over 80 was appropriate [3, 4] with the most recently updated meta-analysis [5] including all IV thrombolysis trials comparing alteplase with placebo, confirming that the elderly population benefitted from treatment. IV thrombolysis is the standard hyperacute reperfusion therapy for AIS within 4.5 hours from symptom onset in all adult age groups worldwide
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