Stroke thrombolysis in the elderly

Abstract

As the population ages the proportion of patients with stroke who are elderly is increasing. With the rise of stroke centers, stroke units, and public education regarding acute stroke intervention, we should expect that many of the patients who present for ultra-early treatment of acute ischemic stroke will be elderly. Therefore, it becomes important to know whether advanced age, in and of itself, should influence how a patient is treated and, specifically, whether recombinant tissue plasminogen activator (t-PA) should be administered. While some might wonder whether age influences t-PA efficacy, the central issue is one of safety. Age is an independent predictor of outcome after ischemic stroke. Older patients, especially those over 80 years old, are more likely to die in the hospital after stroke and less likely to make a favorable long-term recovery.1 The fact that elderly patients are at high risk for stroke-related death and disability makes them an important target group for acute treatment. However, the elderly may also be at increased risk for hemorrhagic complications from t-PA. Older patients have a higher risk of intracranial hemorrhage after thrombolysis for myocardial infarction2 …