Thrombolytic Therapy for Acute Stroke in the Elderly: An Emergent Condition in Developing Countries

• Published in: Journal of stroke and cerebrovascular diseases Vol. 20; no. 5; pp. 459 - 464
• Main Authors: Martins, Sheila Cristina Ouriques, MD, Friedrich, Maurício André Gheller, MD, Brondani, Rosane, MD, de Almeida, Andrea Garcia, MD, de Araújo, Mariana D'Agnino, MD, Chaves, Márcia Lorena Fagundes, MD, Berger, Joseph Robert, MD, Massaro, Ayrton Roberto, MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-09-2011
• Subjects: Age Factors; Aged; Aged, 80 and over; Aging; Brazil - epidemiology; Cardiovascular; Cerebrovascular disease; Chi-Square Distribution; Developing Countries; Female; Fibrinolytic Agents - therapeutic use; Health Services for the Aged; Humans; infarction; Male; Middle Aged; Neurology; Odds Ratio; Prospective Studies; Recombinant Proteins - therapeutic use; Regression Analysis; Risk Assessment; Risk Factors; Stroke - diagnosis; Stroke - drug therapy; Stroke - mortality; Thrombolytic Therapy; Time Factors; Tissue Plasminogen Activator - therapeutic use; Treatment Outcome; Brazil; infarction; Cerebrovascular disease
• ISSN: 1052-3057; 1532-8511
• DOI: 10.1016/j.jstrokecerebrovasdis.2010.02.019

Elderly patients may represent an important group when considering new stroke treatments, particularly in developing countries. The aim of this study was to analyze the use of recombinant tissue plasminogen activator (rtPA) in elderly Brazilian patients with acute ischemic stroke. Clinical and neuroimaging parameters at admission, frequency of symptomatic intracranial hemorrhage, and outcome were compared between elderly (≥80 years) and nonelderly (<80 years) stroke patients treated with rtPA in the Porto Alegre Stroke Network. We evaluated 183 nonelderly patients (mean age, 63 ± 12 years) and 55 elderly patients (mean age, 84 ± 3 years). Female sex, hypertension, congestive heart failure, atrial fibrillation, and previous history of stroke or transient ischemic attack were more frequent in the elderly patients. Elderly patients also presented with higher mean systolic blood pressure ( P = .03) and National Institutes of Health Stroke Scale (NIHSS) score ( P < .0001), whereas the nonelderly patients had a higher serum glucose level ( P = .03). The rate of symptomatic intracranial hemorrhage was 10.9% in the elderly patients and 6.6% in the nonelderly patients ( P = .28), and a substantial proportion of the elderly patients achieved a favorable outcome (modified Rankin Scale score ≤1) at 90 days, although this proportion was lower than that in the nonelderly patients (42% vs 58%; P = .04). Pooer outcomes were generally seen in elderly patients with an anterior circulation stroke, a higher NIHSS score, hypoattenuation in ≥1/3 lf the middle cerebral artery territory, and an Alberta Stroke Program Early CT score of ≤7 on an initial computed tomography scan. Our results support the administration of intravenous rtPA in selected elderly stroke patients presenting early to the hospital in developing countries.