Intravenous Thrombolysis in Patients With Ischemic Stroke Aged ≥90 Years: A Cohort Study From the TRISP Collaboration

被引：11

作者：

Altersberger, Valerian L. ^{[1
,2
,3
]}

Rusche, Norman ^{[1
,2
,3
,4
]}

Martinez-Majander, Nicolas ^{[5
,6
]}

Hametner, Christian ^{[7
]}

Scheitz, Jan F. ^{[8
,9
,10
]}

Henon, Hilde ^{[11
]}

Dell'Acqua, Maria Luisa ^{[12
]}

Strambo, Davide ^{[13
,14
]}

Stolp, Jeffrey ^{[15
]}

Heldner, Mirjam R. ^{[16
,17
]}

Grisendi, Ilaria ^{[18
]}

Jovanovic, Dejana R. ^{[19
]}

Bejot, Yannick ^{[20
]}

Pezzini, Alessandro ^{[21
]}

Leker, Ronen R. ^{[22
]}

Kagi, Georg ^{[16
,17
,23
]}

Wegener, Susanne ^{[24
,25
]}

Cereda, Carlo W. ^{[26
]}

Lindgren, Erik ^{[27
,28
]}

Ntaios, George ^{[29
]}

Piot, Ines ^{[1
,2
,3
]}

Polymeris, Alexandros A. ^{[1
,2
,3
]}

Lyrer, Philippe A. ^{[1
,2
,3
]}

Raty, Silja ^{[5
,6
]}

Sibolt, Gerli ^{[5
,6
]}

Tiainen, Marjaana ^{[5
,6
]}

Heyse, Miriam ^{[7
]}

Erdur, Hebun ^{[8
,9
,10
]}

Kaaouana, Olfa ^{[11
]}

Padjen, Visnja ^{[19
]}

Zedde, Marialuisa ^{[18
]}

Arnold, Marcel ^{[16
,17
]}

Nederkoorn, Paul J. ^{[15
]}

Michel, Patrik ^{[13
,14
]}

Bigliardi, Guido ^{[12
]}

Zini, Andrea ^{[30
,31
]}

Cordonnier, Charlotte ^{[11
]}

Nolte, Christian H. ^{[8
,9
,10
]}

Ringleb, Peter A. ^{[7
]}

Curtze, Sami ^{[5
,6
]}

Engelter, Stefan T. ^{[1
,2
,3
,4
]}

Gensicke, Henrik ^{[1
,2
,3
,4
]}

机构：

[1] Univ Hosp Basel, Stroke Ctr, Basel, Switzerland

[2] Univ Hosp Basel, Dept Neurol, Petersgraben 4, CH-4031 Basel, Switzerland

[3] Univ Basel, Basel, Switzerland

[4] Univ Basel, Univ Dept Geriatr Med FELIX PLATTER, Neurol & Neurorehabil, Basel, Switzerland

[5] Univ Helsinki, Helsinki, Finland

[6] Helsinki Univ Hosp, Helsinki, Finland

[7] Univ Hosp Heidelberg, Dept Neurol, Heidelberg, Germany

[8] Charite Univ Med Berlin, Berlin, Germany

[9] Free Univ Berlin, Berlin, Germany

[10] Humboldt Univ, Klin & Hsch Ambulanz Neurol, Ctr Stroke Res Berlin CSB, Charite Univ Med Berlin,Berlin Inst Hlth, Berlin, Germany

[11] Univ Lille, INSERM, CHU Lille, U1172,LilNCog Lille Neurosci & Cognit, F-59000 Lille, France

[12] Modena Univ Hosp, Dept Neurosci, Neurol, Stroke Unit,Osped Civile Baggiovara, Modena, Italy

[13] Lausanne Univ Hosp, Stroke Ctr, Neurol Serv, Lausanne, Switzerland

[14] Univ Lausanne, Lausanne, Switzerland

[15] Univ Amsterdam, Dept Neurol, Amsterdam UMC Locat, Amsterdam, Netherlands

[16] Bern Univ Hosp, Dept Neurol, Bern, Switzerland

[17] Univ Bern, Bern, Switzerland

[18] Azienda Unita Sanitaria Locale IRCCS Reggio Emili, Neurol Unit, Stroke Unit, Reggio Emilia, Italy

[19] Univ Belgrade, Neurol Clin, Fac Med, Univ Clin Ctr Serbia, Belgrade, Serbia

[20] Univ Hosp Dijon, Dept Neurol, Dijon, France

[21] Univ Brescia, Dept Clin & Expt Sci, Neurol Clin, Brescia, Italy

[22] Hadassah Hebrew Univ Med Ctr, Dept Neurol, Jerusalem, Israel

[23] Kantonsspital St Gallen, Dept Neurol, St Gallen, Switzerland

[24] Univ Hosp Zurich, Dept Neurol, Zurich, Switzerland

[25] Univ Zurich, Zurich, Switzerland

[26] EOC, Neurol, Neuroctr Southern Switzerland, Stroke Ctr EOC, Lugano, Switzerland

[27] Univ Gothenburg, Sahlgrenska Acad, Inst Neurosci & Physiol, Dept Clin Neurosci, Gothenburg, Sweden

[28] Sahlgrens Univ Hosp, Dept Neurol, Gothenburg, Sweden

[29] Univ Thessaly, Fac Med, Sch Hlth Sci, Dept Internal Med, Larisa, Greece

[30] Maggiore Hosp, Dept Neurol, IRCCS Ist Sci Neurol Bologna, Bologna, Italy

[31] Maggiore Hosp, Stroke Ctr, Bologna, Italy

来源：

STROKE | 2022年 / 53卷 / 12期

关键词：

aged; intracranial hemorrhage; ischemic stroke; registries; survivors; TISSUE-PLASMINOGEN ACTIVATOR; NONAGENARIANS; OUTCOMES; TRIAL;

D O I：

10.1161/STROKEAHA.122.039426

中图分类号：

R74 [神经病学与精神病学];

学科分类号：

摘要：

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 16974 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 ratio(adjusted) 1.14 [0.83-1.57]) did not differ significantly between both groups. However, the probability of death (odds ratio(adjusted) 3.77 [3.14-4.53]) and poor functional outcome (odds ratio(adjusted) 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.

引用

页码：3557 / 3563

页数：7

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