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.