TPA for ischemic stroke in patients ≥80 years.
Although patients >80 years were excluded in RCTs for tPA treatment of acute ischemic stroke (AIS), many centers treat old patients. We wanted to examine whether age ≥80 years is an independent predictor of outcome after tPA. We included 77 consecutive patients ≥80 years and 83 patients <80 years treated with tPA within 4.5 h after onset of AIS. Baseline variables were analyzed by multiple stepwise logistic regression analyses against three outcomes: symptomatic intracerebral hemorrhage (sICH), death and good functional outcome (mRS, 0-1) at 3-month follow-up. Age ≥80 years was associated with increased risk of sICH (OR, 18.2 [95% CI, 1.0-324.1], P = 0.048), and death (OR, 3.3 [95% CI, 1.2-9.1], P = 0.018), but not with functional outcome at 3 months. Other factors associated with death were longer onset to treatment time (OTT) (OR, 1.007/min increase [95% CI, 1.00-1.015], P = 0.047), higher NIHSS (OR, 1.12 per point increase [95% CI, 1.04-1.19], P = 0.001), and previous stroke (OR, 4.0 [95% CI, 1.2-13.7], P = 0.03). Predictors of good functional outcome were shorter OTT (OR, 0.99 [95% CI, 0.98-1.00], P = 0.02) and lower NIHSS (OR, 0.80 [95% CI, 0.74-0.87] P ≤ 0.001). Age ≥80 years might be an independent risk factor for sICH and death the first 3 months after treatment with tPA for AIS, but does not influence the chance of a good functional outcome. We suggest to treat patients over 80 years with tPA, but be cautious if the time from onset (OTT) is long.