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| Age not related to incidence of ICH after thrombolysis |
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06 March 2006
Findings from the largest study of thrombolysis in elderly stroke patients to date suggest that those aged 80 years or over do not have an elevated risk of intracerebral haemorrhage (ICH) compared with their younger counterparts. These findings refute those of smaller observational studies, which reported an increased incidence of thrombolysis-related ICH in very elderly stroke patients compared with those under the age of 80 years.
The investigators of the Canadian Alteplase for Stroke Effectiveness Study (CASES), led by Dr P Sylaja, from the University of Calgary in Alberta, Canada, reviewed the outcomes of 1135 stroke patients who were treated with tissue plasminogen activator. Their findings, reported in the Journal of Neurology, Neurosurgery, and Psychiatry, show that the rates of symptomatic ICH were similar in the 270 patients aged 80 years or over and the 865 younger patients, at 4.4% and 4.6%, respectively. After 90 days, 26% of the oldest patients had modified Rankin Scale scores of 0 or 1, whereas 40% of younger patients achieved this favourable outcome.
It was noted that atrial fibrillation was present in 37% of the very elderly stroke patients compared with those who were aged less than 80 years, congestive heart failure was identified in 11% and 6%, respectively, and hypertension was present in 59% and 48%, respectively. Furthermore, the oldest patients also had more severe strokes, with an average National Institutes of Health Stroke Scale score of 16, compared with 14 for younger patients.
The researchers therefore suggest that "rather than age alone, a complex interplay of stroke severity, comorbid conditions, and pre-existing disability accounts for the overall poor outcome in the elderly." Citing previous studies showing that elderly stroke patients have a higher mortality rate if not treated with thrombolysis, they suggest "that an aggressive approach to acute stroke care is warranted in elderly patients."
Reference:
J Neurol Neurosurg Psychiatry 2006; Epub ahead of print.
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