TY - JOUR
T1 - Thrombolysis for stroke in elderly in the late window period
AU - Mowla, Ashkan
AU - Shakibajahromi, Banafsheh
AU - Arora, Ashish
AU - Seifi, Ali
AU - Sawyer, Robert N.
AU - Shirani, Peyman
N1 - Publisher Copyright:
© 2021 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
PY - 2021/12
Y1 - 2021/12
N2 - Objectives: Safety of intravenous thrombolysis (IVT) within 3–4.5 hours of stroke onset in patients ≥80 years is still disputable. We evaluated the association of symptom onset-to-treatment time (SOTT) with the symptomatic intracranial hemorrhage (sICH), poor outcome, and mortality in patients≥80 years. Materials and Methods: In a retrospective study, patients treated with IVT following stroke were registered. Outcomes were poor outcome (mRS>2), sICH/ECASS-2, and in-hospital mortality. We compared the patients≥80 years who received IVT within 3 hours with those receiving IVT within 3–4.5 hours. We further compared the patients who were <80 years with those ≥80 years and SOTT of 3–4.5 hours. Results: Of 834 patients, 265 aged over 80. In those above 80 and in multivariable analysis, the associations of SOTT with poor outcome (aOR: 1.401, CI: 0.503–3.903, p=0.519), sICH (aOR=2.50, CI=0.76–8.26, p= 0.132) and mortality (aOR=1.12, CI=0.39–3.25, p= 0.833) were not significant. 106 patients received IVT within 3–4.5 hours. In multivariable analysis, the associations of age (≥80 versus <80) with poor outcome (aOR=1.87, CI=0.65–5.37, p=0.246), sICH (aOR=0.65, CI=0.14–3.11, p=0.590), and mortality (aOR=0.87, 95% CI=0.16–4.57, p=0.867) were not significant in patients with SOTT of 3–4.5 hours. Conclusion: IVT within 3–4.5 hours in patients ≥80 years is not associated with increased sICH, poor outcome, and mortality compared to the early time window, and also compared to the younger patients in 3–4.5 hours window period. The decision of IVT administration in this age group should not be made solely on the basis of stroke onset timing.
AB - Objectives: Safety of intravenous thrombolysis (IVT) within 3–4.5 hours of stroke onset in patients ≥80 years is still disputable. We evaluated the association of symptom onset-to-treatment time (SOTT) with the symptomatic intracranial hemorrhage (sICH), poor outcome, and mortality in patients≥80 years. Materials and Methods: In a retrospective study, patients treated with IVT following stroke were registered. Outcomes were poor outcome (mRS>2), sICH/ECASS-2, and in-hospital mortality. We compared the patients≥80 years who received IVT within 3 hours with those receiving IVT within 3–4.5 hours. We further compared the patients who were <80 years with those ≥80 years and SOTT of 3–4.5 hours. Results: Of 834 patients, 265 aged over 80. In those above 80 and in multivariable analysis, the associations of SOTT with poor outcome (aOR: 1.401, CI: 0.503–3.903, p=0.519), sICH (aOR=2.50, CI=0.76–8.26, p= 0.132) and mortality (aOR=1.12, CI=0.39–3.25, p= 0.833) were not significant. 106 patients received IVT within 3–4.5 hours. In multivariable analysis, the associations of age (≥80 versus <80) with poor outcome (aOR=1.87, CI=0.65–5.37, p=0.246), sICH (aOR=0.65, CI=0.14–3.11, p=0.590), and mortality (aOR=0.87, 95% CI=0.16–4.57, p=0.867) were not significant in patients with SOTT of 3–4.5 hours. Conclusion: IVT within 3–4.5 hours in patients ≥80 years is not associated with increased sICH, poor outcome, and mortality compared to the early time window, and also compared to the younger patients in 3–4.5 hours window period. The decision of IVT administration in this age group should not be made solely on the basis of stroke onset timing.
KW - 3–4.5 hours
KW - age ≥80 years
KW - elderly
KW - intravenous thrombolysis
KW - late window period
KW - outcome
KW - stroke
UR - http://www.scopus.com/inward/record.url?scp=85111129572&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85111129572&partnerID=8YFLogxK
U2 - 10.1111/ane.13512
DO - 10.1111/ane.13512
M3 - Article
C2 - 34314036
AN - SCOPUS:85111129572
SN - 0001-6314
VL - 144
SP - 663
EP - 668
JO - Acta Neurologica Scandinavica
JF - Acta Neurologica Scandinavica
IS - 6
ER -