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| Stroke thrombolysis risky in very old patients |
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18 April 2006
Because the likelihood of a favourable neurologic outcome in stroke patients over the age of 80 is lower than that of younger patients, it is unclear whether such older patients experience more benefit than harm from t-PA thrombolysis, new research shows. Further, their bleeding risk is higher.
The current findings raise the "question of whether the use of recombinant t-PA is justified in patients over 80 years of age," lead author Dr Robert J. van Oostenbrugge and colleagues, from the University Hospital Maastricht in the Netherlands, conclude.
In the present study, appearing in the Journal of Neurology, Neurosurgery, and Psychiatry for March, Dr van Oostenbrugge's team describe the outcomes of 184 consecutive stroke patients treated with t-PA at their centre. The main focus was on the 45 patients who were 80 years of age or older. Twenty-seven percent of very old patients had a favourable outcome, defined as a modified Rankin scale score of no greater than 1. By contrast, the percentage among younger patients was much higher - 45%. Similarly, a good outcome (a Rankin score of no greater than 2) was noted in 36% and 63% of these patients, respectively. The rate of symptomatic intracranial haemorrhage in the very old group was 11.1% compared with a rate of just 2.9% in younger patients, resulting in an odds ratio of 4.22.
"Some argue that intravenous thrombolysis should be administered to the very old based on an individualised risk/benefit analysis," the authors state. "However, our findings underline the plea for more data on pre-specified groups from randomised controlled trials."
Reference:
J Neurol Neurosurg Psychiatry 2006; 77 (3): 375-377.
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