Outcome and severe hemorrhagic complications of intravenous thrombolysis with tissue plasminogen activator in very old (≥80 years) stroke patients

Background and Purpose - Information on safety and efficacy of intravenous thrombolysis with tissue plasminogen activator (tPA) (IV-tPA) in very old acute ischemic stroke (AIS) patients is scarce. We studied outcome and severe hemorrhagic complications in patients aged 80 and older. Methods - We analyzed data of AIS patients, treated with IV-tPA, in 3 German stroke centers. Neurologic deficit on admission was assessed using the National Institutes of Health Stroke Scale (NIHSS). Outcome was assessed after 90 days using the Modified Rankin Scale (MRS), and favorable outcome was defined as a MRS score of 0 to 1. Severe intracerebral bleeding complications were assessed on follow-up magnetic resonance imaging or cranial computed tomography. Data were compared between patients < 80 years of age and patients aged >= 80 years. Results - A total of 228 patients were treated with IV-tPA; 38 (16%) were 80 years or older. There was no difference in NIHSS on admission or onset to treatment time between younger and older patients. Less patients < 80 years of age achieved a favorable outcome (26.3 versus 46.8%, P = 0.021), and mortality was higher in older patients (21.1 versus 5.3%, P = 0.004). There was no difference in the rate of parenchymal hemorrhage (6.3% < 80 years versus 5.3% >= 80 years, P = 1.000) and symptomatic intracerebral hemorrhage (2.6% < 80 years versus 2.6% >= 80 years, P = 1.000) between both groups. Conclusion - There is no increase in severe intracerebral hemorrhage after IV-tPA in very old patients, but outcome is worse as compared with younger patients. There is no evidence to exclude ischemic stroke patients from thrombolysis based on a predefined age threshold.