Rohan Arora1, Elliott Salamon1, Jeffrey M Katz1, Margueritte Cox1, Jeffrey L Saver2, Deepak L Bhatt1, Gregg C Fonarow1, Eric D Peterson1, Eric E Smith1, Lee H Schwamm1, Ying Xian1, Richard B Libman1. 1. From the Department of Neurology, Hofstra Northwell School of Medicine, Hempstead, NY (R.A., E.S., J.M.K., R.B.L); Outcomes Research and Assessment Group (M.C.), Division of Cardiology, Department of Medicine (E.D.P.), and Department of Neurology (Y.X.), Duke Clinical Research Institute, Durham, NC; Department of Neurology and Comprehensive Stroke Center, David Geffen School of Medicine (J.L.S.) and Division of Cardiology (G.C.F.), University of California, Los Angeles; Brigham and Women's Heart and Vascular Center and Harvard Medical School, Boston, MA (D.L.B.); Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Alberta, Canada (E.E.S.); and Stroke Service, Department of Neurology, Massachusetts General Hospital, Boston (L.H.S.). 2. From the Department of Neurology, Hofstra Northwell School of Medicine, Hempstead, NY (R.A., E.S., J.M.K., R.B.L); Outcomes Research and Assessment Group (M.C.), Division of Cardiology, Department of Medicine (E.D.P.), and Department of Neurology (Y.X.), Duke Clinical Research Institute, Durham, NC; Department of Neurology and Comprehensive Stroke Center, David Geffen School of Medicine (J.L.S.) and Division of Cardiology (G.C.F.), University of California, Los Angeles; Brigham and Women's Heart and Vascular Center and Harvard Medical School, Boston, MA (D.L.B.); Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Alberta, Canada (E.E.S.); and Stroke Service, Department of Neurology, Massachusetts General Hospital, Boston (L.H.S.). jsaver@mednet.ucla.edu.
Abstract
BACKGROUND AND PURPOSE: Intravenous tissue-type plasminogen activator (tPA) is a proven treatment for acute ischemic stroke, but there has been limited evaluation among patients aged ≥90 years. METHODS: We analyzed data from the Get With The Guidelines-Stroke national quality improvement registry from January 2009 to April 2013. Frequency, determinants, and outcomes of tPA use were compared among patients aged ≥90 and 3 younger age groups (18-64, 65-79, and 80-89 years). RESULTS: Among 35 708 patients from 1178 sites who arrived within 2 hours of time last known well and received tPA, 2585 (7.2%) were ≥90 years. Compared with younger patients, the rate of tPA use among patients without a documented contraindication was lower among patients aged ≥90 years (67.4% versus 84.1% in 18-89-year olds; P<0.0001). Discharge outcomes among individuals aged ≥90 years included discharge to home or acute rehabilitation in 31.4%, independent ambulation at discharge in 13.4%, symptomatic hemorrhage in 6.1%, and in-hospital mortality or hospice discharge in 36.4%. On multivariable analysis, good functional outcomes generally occurred less often and mortality more often among patients aged ≥90 years. The risk of symptomatic hemorrhage was increased compared with patients <65 years but was not significantly different than the risk in 66- to 89-year olds. CONCLUSIONS: The use of intravenous tPA among those aged ≥90 years is lower than in younger patients. When fibrinolytic therapy is used, the risk of symptomatic hemorrhage is not higher than in 66- to 89-year olds; however, mortality is higher and functional outcomes are lower.
BACKGROUND AND PURPOSE: Intravenous tissue-type plasminogen activator (tPA) is a proven treatment for acute ischemic stroke, but there has been limited evaluation among patients aged ≥90 years. METHODS: We analyzed data from the Get With The Guidelines-Stroke national quality improvement registry from January 2009 to April 2013. Frequency, determinants, and outcomes of tPA use were compared among patients aged ≥90 and 3 younger age groups (18-64, 65-79, and 80-89 years). RESULTS: Among 35 708 patients from 1178 sites who arrived within 2 hours of time last known well and received tPA, 2585 (7.2%) were ≥90 years. Compared with younger patients, the rate of tPA use among patients without a documented contraindication was lower among patients aged ≥90 years (67.4% versus 84.1% in 18-89-year olds; P<0.0001). Discharge outcomes among individuals aged ≥90 years included discharge to home or acute rehabilitation in 31.4%, independent ambulation at discharge in 13.4%, symptomatic hemorrhage in 6.1%, and in-hospital mortality or hospice discharge in 36.4%. On multivariable analysis, good functional outcomes generally occurred less often and mortality more often among patients aged ≥90 years. The risk of symptomatic hemorrhage was increased compared with patients <65 years but was not significantly different than the risk in 66- to 89-year olds. CONCLUSIONS: The use of intravenous tPA among those aged ≥90 years is lower than in younger patients. When fibrinolytic therapy is used, the risk of symptomatic hemorrhage is not higher than in 66- to 89-year olds; however, mortality is higher and functional outcomes are lower.
Authors: J M Katz; J J Wang; A T Boltyenkov; G Martinez; J O'Hara; C Feizullayeva; M Gribko; A Pandya; P C Sanelli Journal: AJNR Am J Neuroradiol Date: 2021-08-12 Impact factor: 4.966
Authors: Amelia K Adcock; Lee H Schwamm; Eric E Smith; Gregg C Fonarow; Mathew J Reeves; Haolin Xu; Roland A Matsouaka; Ying Xian; Jeffrey L Saver Journal: JAMA Netw Open Date: 2022-06-01