TY - JOUR
T1 - Comparison of acute nonthrombolytic and thrombolytic treatments in ischemic stroke patients 80 years or older
AU - Zacharatos, Haralabos
AU - Hassan, Ameer E.
AU - Vazquez, Gabriela
AU - Hussein, Haitham M.
AU - Rodriguez, Gustavo J.
AU - Suri, M. Fareed K.
AU - Lakshminarayan, Kamakshi
AU - Ezzeddine, Mustapha A.
AU - Qureshi, Adnan I.
N1 - Funding Information:
This research was not financially supported by any grant or external funding source.
Copyright:
Copyright 2012 Elsevier B.V., All rights reserved.
PY - 2012/1
Y1 - 2012/1
N2 - Objectives: The aim of this study was to compare the clinical outcomes of acute ischemic stroke patients 80 years or older treated with intravenous recombinant tissue plasminogen activator (IV rt-PA), or endovascular intervention with or without IV rt-PA, or nonthrombolytic medical treatment. Methods: This study was a retrospective, nonrandomized, observational study of patients, admitted within 9 hours of symptom onset, at 3 academic, university-affiliated hospitals. The main outcome measures were neurologic improvement, defined by improvement in National Institutes of Health Stroke Scale score at 7 days or discharge of 4 or more, or achieving a score of 0; symptomatic and asymptomatic intracerebral hemorrhage; favorable outcome (discharge modified Rankin score 0-2); and in-hospital mortality. Results: A total of 44 patients received IV rt-PA, 46 received endovascular intervention with or without IV rt-PA, and 66 received nonthrombolytic medical treatment. IV rt-PA-treated patients had a significantly clinically higher chance of favorable outcome (odds ratio [OR], 5.6; 95% confidence interval [CI], 1.8-17.5), when compared with nonthrombolytic medical treatment. A significantly higher rate of neurologic improvement was observed among the IV rt-PA (7.2; 95% CI, 2.7-19.5) and endovascularly treated patients (5.8; 95% CI, 2-16.8) when compared with nonthrombolytic medical treatment. Conclusions: A prominently higher rate of neurologic improvement and favorable clinical outcome was observed among acute ischemic stroke patients 80 years or older treated with IV rt-PA or endovascular intervention when compared with nonthrombolytic medical treatment, supporting the use of acute thrombolytic therapies in this patient population when contraindications are not present.
AB - Objectives: The aim of this study was to compare the clinical outcomes of acute ischemic stroke patients 80 years or older treated with intravenous recombinant tissue plasminogen activator (IV rt-PA), or endovascular intervention with or without IV rt-PA, or nonthrombolytic medical treatment. Methods: This study was a retrospective, nonrandomized, observational study of patients, admitted within 9 hours of symptom onset, at 3 academic, university-affiliated hospitals. The main outcome measures were neurologic improvement, defined by improvement in National Institutes of Health Stroke Scale score at 7 days or discharge of 4 or more, or achieving a score of 0; symptomatic and asymptomatic intracerebral hemorrhage; favorable outcome (discharge modified Rankin score 0-2); and in-hospital mortality. Results: A total of 44 patients received IV rt-PA, 46 received endovascular intervention with or without IV rt-PA, and 66 received nonthrombolytic medical treatment. IV rt-PA-treated patients had a significantly clinically higher chance of favorable outcome (odds ratio [OR], 5.6; 95% confidence interval [CI], 1.8-17.5), when compared with nonthrombolytic medical treatment. A significantly higher rate of neurologic improvement was observed among the IV rt-PA (7.2; 95% CI, 2.7-19.5) and endovascularly treated patients (5.8; 95% CI, 2-16.8) when compared with nonthrombolytic medical treatment. Conclusions: A prominently higher rate of neurologic improvement and favorable clinical outcome was observed among acute ischemic stroke patients 80 years or older treated with IV rt-PA or endovascular intervention when compared with nonthrombolytic medical treatment, supporting the use of acute thrombolytic therapies in this patient population when contraindications are not present.
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U2 - 10.1016/j.ajem.2010.11.019
DO - 10.1016/j.ajem.2010.11.019
M3 - Article
C2 - 21247724
AN - SCOPUS:81755167280
SN - 0735-6757
VL - 30
SP - 158
EP - 164
JO - American Journal of Emergency Medicine
JF - American Journal of Emergency Medicine
IS - 1
ER -
