Thrombolysis In Elderly Patients Research Articles

Retracted: Nursing Process Design of Intravenous Thrombolysis in Elderly Patients with Acute Cerebral Infarction.

[This retracts the article DOI: 10.1155/2022/2047948.].

EKOSTM in Octogenarians: The Safety and Efficacy of Ultrasound-Accelerated Catheter-Directed Thrombolysis in Elderly Patients with Intermediate-High-Risk Pulmonary Embolism.

Pulmonary embolism (PE) is a common cardiovascular disease. Elderly patients with acute PE have very high mortality rates. Data concerning the safety and effectiveness of ultrasound-accelerated thrombolysis (USAT) in this age group are lacking. Nineteen octogenarians with acute pulmonary embolism underwent USAT between August 2020 and February 2023 at two centres in Germany and were retrospectively analysed. The main efficacy measures were the right ventricle to left ventricle diameter (RV/LV) ratio, systolic right ventricle function, and invasive and echocardiographic measured systolic pulmonary artery pressure (sPAP). The main safety measures were in-hospital death and the bleeding rate according to the GUSTO bleeding score. USAT was associated with an improved RV/LV ratio (0.36 ± 0.29, p < 0.001), systolic right ventricle function (5.0 ± 3.8, p < 0.001), and systolic pulmonary artery pressure (sPAP) at 24 h after therapy (24.2 ± 11.2 mmHg and 19 ± 13.4 mmHg, p < 0.001). No in-hospital deaths or bleeding complications occurred. USAT with EKOSTM may be a safe and effective therapeutic option for octogenarians with acute pulmonary embolism.

Final benefit of primary percutaneous coronary intervention for ST-elevation myocardial infarction in older patients: long-term results of arandomised trial.

Although the short-term benefit of primary percutaneous coronary intervention (PCI) in elderly patients with ST-elevation myocardial infarction (STEMI) has been demonstrated, the final long-term survival benefit is as yet unknown. To assess the final survival benefit of primary PCI as compared to thrombolytic therapy in patients over 75years of age. Patients > 75years with STEMI were randomised to either primary PCI or thrombolysis. Long-term data on survival were available for all patients. Atotal of 46patients were randomised to primary PCI, 41to thrombolysis. There were no significant differences in baseline variables. After amaximum of 20years' follow-up, all patients had passed away. The patients randomised to thrombolysis died after amean follow-up duration of 5.2years (SD 4.9) compared to 6.7years (SD 4.8) in patients randomised to primary PCI (p = 0.15). Thus, the mean final survival benefit of primary PCI was 1.5years. The final survival benefit of primary PCI as compared to thrombolysis in elderly patients with STEMI is 1.5years and their life expectancy increases by 28.8%.

Nursing Process Design of Intravenous Thrombolysis in Elderly Patients with Acute Cerebral Infarction.

The economy of contemporary society is developing rapidly and the society is making continuous progress. The population is aging and diet structure is also adjusted. Acute cerebral infarction(ACI) in the elderly has become a common disease that seriously threatens the health of the elderly. Therefore, research on nursing of senile ACI is of great significance. Nursing is essential in the thrombolytic therapy of cerebral infarction. This article aims to study the process design of intravenous thrombolytic nursing for elderly patients with ACI and the conclusions are as follows: the nursing process has a good nursing effect. This increased the Barthel index of elderly patients with ACI after intravenous thrombolysis care by 15.8 compared with that before care. Compared with the traditional nursing mode, the nursing course and cost are significantly reduced.

Clinical Outcomes after Intravenous Alteplase in Elderly Patients with Acute Ischaemic Stroke: A Retrospective Analysis of Patients Treated at a Tertiary Neurology Centre in England from 2013 to 2018.

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.

Effect of Age on Arterial Recanalization and Clinical Outcome in Thrombolyzed Acute Ischemic Stroke in CLOTBUST Cohort.

Background and Aims:Despite the evidence from randomized clinical trials, the effectiveness of intravenous tissue recombinant plasminogen activator (IV-tPA) for elderly patients (≥80 yrs) with acute ischemic stroke (AIS) is often an important consideration in clinical practice. We evaluated the effect of older age on arterial recanalization, timing of recanalization and outcome in thrombolysed AIS patients.Methods:Consecutive AIS patients treated with IV-tPA and transcranial Doppler (TCD) examination within 3 hours of symptom-onset were included. Thrombolysis in Brain Ischemia (TIBI) flow-grading system was used to interpret TCD findings of persistent occlusion, re-occlusion and complete recanalization within 2 hours of IV-tPA bolus. Poor functional outcome was defined by modified Rankin score of 3 or more. Univariate and multiple logistic regression analyses were performed to assess the effect of age on clinical and TCD outcome measures.Results:The study included 361 patients (elderly = 85, <80 yrs = 276). Median age was 68 years (range 18-91 years). Compared to the elderly, younger patients (<80 years) were more females (63.5% versus 41.3%), had higher baseline National Institute of Health Stroke Scale score (17.5 versus 16.0 points) and shorter time from symptom-onset to IV-tPA bolus (median 136.6 versus 139.7 minutes). No significant differences were noted between the site of arterial occlusion, TCD outcome measures or time of complete recanalization between the 2 groups. More patients aged < 80 years achieved good functional outcome (51.9% versus 31.8% in the older age group; P = 0.004). IV-tPA induced recanalization and symptomatic intracranial hemorrhage were similar in the 2 groups. Multivariate logistic regression showed elderly age as an independent predictor of poor outcome (adjusted OR 2.5, 95%CI 1.26-4.95; P = 0.008).Conclusion:Elderly AIS patients achieve relatively poor functional outcome after IV-tPA despite similar rates of arterial recanalization. However, there is no increase in the hemorrhagic risk. Perhaps, decision for IV thrombolysis in elderly patients should be made cautiously.

Thrombolysis, stroke-unit admission and early rehabilitation in elderly patients

Few elderly patients have been included in randomized trials assessing recombinant tissue plasminogen activator (rtPA) in stroke. In North America, intravenous thrombolysis is allowed in these patients; however, the European Medicines Agency does not recommend rtPA for the treatment of stroke in patients over 80 years of age. The influence of age on outcome following stroke-unit care and rehabilitation also remains controversial. In the absence of randomized trials, the efficacy of thrombolysis in elderly patients is difficult to measure. The majority of rtPA cohort studies demonstrate that patients over 80 years of age have lower rates of positive outcomes following treatment than younger patients. These studies are, however, reassuring with regard to the risk of symptomatic intracerebral hemorrhage and death, and suggest that rtPA can be safely administered to carefully selected elderly patients within 3 h of the onset of stroke. Further randomized studies will lead to more-accurate conclusions about the efficacy and safety of rtPA in the elderly subgroup. Admission to a stroke unit rather than to a general ward and early rehabilitation are justified in elderly patients. In this article, we review the literature regarding the effect of thrombolysis, stroke-unit care, and rehabilitation in patients over 80 years of age with stroke.

Gap care in diagnostic and prognostic evaluation of chest pain in the elderly

Despite the greater prevalence of coronary disease, aortic pathology and pulmonary thrombolysis in elderly patients, some studies have shown under-utilization of diagnostic and therapeutic resources in this age group.

Thrombolysis in elderly patients with acute myocardial infarction.

The efficacy of thrombolytic therapy in the elderly remains a topic of ongoing debate. Although elderly patients account for a disproportionate amount of cardiovascular mortality, they have typically been underrepresented in randomized clinical trials. A meta-analysis of these trials suggests a survival benefit, albeit small, of thrombolytic therapy in the elderly. Thrombolytic therapy, in combination with either glycoprotein IIb/IIIa inhibitors or low-molecular weight heparin, poses an increased hazard in the elderly. Observational studies of thrombolytic therapy in the elderly portray a far worse outcome than the randomized clinical trials and raise the possibility of increased mortality. To date, no randomized trial has compared thrombolytic and primary coronary intervention in the elderly. However, multiple observational studies indicate a low risk of intracerebral hemorrhage and improved survival when a strategy of primary coronary intervention is employed. Future trials and observational studies should elucidate the ideal reperfusion strategy in the elderly.

Primary angioplasty with routine stenting compared with thrombolytic therapy in elderly patients with acute myocardial infarction

BackgroundPrior studies have yielded conflicting data on the advantage of primary angioplasty compared with thrombolysis in elderly patients with acute myocardial infarction (AMI). These studies, however, were performed before the contemporary widespread use of intracoronary stents and glycoprotien IIb/IIIa antagonists. MethodsWe prospectively compared the outcome of 130 consecutive elderly patients (aged ≥70 years) with ST-elevation AMI who were admitted to 2 similar neighboring medical centers. Patients were assigned to receive either thrombolytic therapy with accelerated tissue-type plasminogen activator (center I) or primary angioplasty with routine stenting (center II). ResultsOf the patients assigned to receive primary angioplasty, 91% underwent stenting. At 6 months, patients treated with primary angioplasty, compared with those treated with thrombolytic therapy, had a lower incidence of reinfarction (2% vs 14%, P = .053) and revascularization for recurrent ischemia (9% vs 61%, P < .001) and a significant reduction in the prespecified combined end point of death, reinfarction, or revascularization for recurrent ischemia (29% vs 93%, P < .01). Primary angioplasty remained an independent predictor of the triple combined end point after controlling for potential covariables (relative risk 0.63, 95% CI 0.38–0.84). Major bleeding complications were also significantly reduced in the primary angioplasty group (0% vs 17%, P = .03). ConclusionsCompared with thrombolysis, primary angioplasty with routine stenting in elderly patients with AMI is associated with better clinical outcomes and a lower risk of bleeding complications.

PTCA superior to thrombolysis in elderly patients with acute MI?

PTCA superior to thrombolysis in elderly patients with acute MI?