Intravenous rt-PA for acute stroke: Comparing its effectiveness in younger and older patients

M. S. Mouradian, A. Senthilselvan, G. Jickling, J. A. McCombe, D. J. Emery, N. Dean, A. Shuaib

Research output: Contribution to journalArticle

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Abstract

Objective: To study the short and long term differences in outcome between patients ≥80 years of age and those ≤79 years of age who received intravenous recombinant tissue plasminogen activator (iv rt-PA) for acute stroke within the first 3 hours of symptom onset. Methods: We studied consecutive patients treated with iv rt-PA for acute stroke, with prospective follow up of up to 3 years. Outcome measures included National Institutes of Health Stroke Scale (NIHSS) score, Barthel Index (BI), modified Rankin score (MRS), and stroke mortality. Patients were split into two groups: younger (≤79 years) and older (≥80 years). Results: There were 65 patients in the younger cohort and 31 patients in the older. Older patients were more likely to present with more severe baseline stroke (p = 0.04; odds ratio (OR) 3.04; 95% confidence interval (CI) 1.03 to 8.98). Stroke mortality at 90 days was 10.8% in the younger and 32.3% in the older cohort (p = 0.01). At 90 days' follow up, patients in the older cohort with more severe stroke (NIHSS score ≥11) were nearly 10 times more likely to have poor outcome compared with their younger counterparts presenting with severe stroke (p = 0.001; OR = 10.36; 95% CI 2.16 to 49.20). Baseline stroke severity and age were the only independent and equal predictors for stroke outcome. No threshold was found for age or baseline stroke severity predicting outcome. Conclusion: Older patients presenting with more severe baseline stroke are much less likely to benefit from iv rt-PA as compared with their younger counterparts.

Original languageEnglish (US)
Pages (from-to)1234-1237
Number of pages4
JournalJournal of Neurology, Neurosurgery and Psychiatry
Volume76
Issue number9
DOIs
StatePublished - Sep 2005
Externally publishedYes

Fingerprint

Stroke
Tissue Plasminogen Activator
National Institutes of Health (U.S.)
Odds Ratio
Confidence Intervals
Mortality
Outcome Assessment (Health Care)

ASJC Scopus subject areas

  • Neuropsychology and Physiological Psychology
  • Neuroscience(all)
  • Psychiatry and Mental health

Cite this

Mouradian, M. S., Senthilselvan, A., Jickling, G., McCombe, J. A., Emery, D. J., Dean, N., & Shuaib, A. (2005). Intravenous rt-PA for acute stroke: Comparing its effectiveness in younger and older patients. Journal of Neurology, Neurosurgery and Psychiatry, 76(9), 1234-1237. https://doi.org/10.1136/jnnp.2004.047803

Intravenous rt-PA for acute stroke : Comparing its effectiveness in younger and older patients. / Mouradian, M. S.; Senthilselvan, A.; Jickling, G.; McCombe, J. A.; Emery, D. J.; Dean, N.; Shuaib, A.

In: Journal of Neurology, Neurosurgery and Psychiatry, Vol. 76, No. 9, 09.2005, p. 1234-1237.

Research output: Contribution to journalArticle

Mouradian, MS, Senthilselvan, A, Jickling, G, McCombe, JA, Emery, DJ, Dean, N & Shuaib, A 2005, 'Intravenous rt-PA for acute stroke: Comparing its effectiveness in younger and older patients', Journal of Neurology, Neurosurgery and Psychiatry, vol. 76, no. 9, pp. 1234-1237. https://doi.org/10.1136/jnnp.2004.047803
Mouradian, M. S. ; Senthilselvan, A. ; Jickling, G. ; McCombe, J. A. ; Emery, D. J. ; Dean, N. ; Shuaib, A. / Intravenous rt-PA for acute stroke : Comparing its effectiveness in younger and older patients. In: Journal of Neurology, Neurosurgery and Psychiatry. 2005 ; Vol. 76, No. 9. pp. 1234-1237.
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AU - McCombe, J. A.

AU - Emery, D. J.

AU - Dean, N.

AU - Shuaib, A.

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N2 - Objective: To study the short and long term differences in outcome between patients ≥80 years of age and those ≤79 years of age who received intravenous recombinant tissue plasminogen activator (iv rt-PA) for acute stroke within the first 3 hours of symptom onset. Methods: We studied consecutive patients treated with iv rt-PA for acute stroke, with prospective follow up of up to 3 years. Outcome measures included National Institutes of Health Stroke Scale (NIHSS) score, Barthel Index (BI), modified Rankin score (MRS), and stroke mortality. Patients were split into two groups: younger (≤79 years) and older (≥80 years). Results: There were 65 patients in the younger cohort and 31 patients in the older. Older patients were more likely to present with more severe baseline stroke (p = 0.04; odds ratio (OR) 3.04; 95% confidence interval (CI) 1.03 to 8.98). Stroke mortality at 90 days was 10.8% in the younger and 32.3% in the older cohort (p = 0.01). At 90 days' follow up, patients in the older cohort with more severe stroke (NIHSS score ≥11) were nearly 10 times more likely to have poor outcome compared with their younger counterparts presenting with severe stroke (p = 0.001; OR = 10.36; 95% CI 2.16 to 49.20). Baseline stroke severity and age were the only independent and equal predictors for stroke outcome. No threshold was found for age or baseline stroke severity predicting outcome. Conclusion: Older patients presenting with more severe baseline stroke are much less likely to benefit from iv rt-PA as compared with their younger counterparts.

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