Original Article
Older Age Does Not Increase Risk of Hemorrhagic Complications after Intravenous and/or Intra-Arterial Thrombolysis for Acute Stroke

https://doi.org/10.1016/j.jstrokecerebrovasdis.2008.03.003Get rights and content

Background

The elderly have significantly higher incidence of ischemic stroke and have higher mortality and morbidity compared with younger patients. Intracranial hemorrhage (ICH) after thrombolysis is one of the causes of unfavorable outcome. However, it is unclear whether age over 80 years is a predictor for hemorrhagic transformation after intravenous, intra-arterial, or a combination of both thrombolytic therapies.

Methods

A database of 488 consecutive patients with ischemic stroke who received thrombolytic therapy was analyzed using logistic regression model to determine whether factors such as age over 80 years, demographic characteristics, onset to treatment time, severity of neurologic deficits, route of administration, blood glucose, or mean arterial pressure were associated with symptomatic ICH.

Results

The rates of symptomatic hemorrhage were 12.82% and 10.4% in older and younger groups, respectively. The odds of symptomatic hemorrhage after thrombolytic therapy for patients over 80 years of age after adjusting for route of administration, National Institutes of Health Stroke Scale score, mean arterial pressure, and glucose was not significantly different from that of the younger age group (odds ratio [OR] = 1.64; 95% confidence interval [CI]: 0.729-3.66). Hyperglycemia (>150 mg/dL) was associated with increased odds of symptomatic ICH (OR = 2.32; 95% CI: 1.09-4.93). Patients older than 80 years had similar rates of recanalization (OR = 0.8; 95% CI: 0.4-1.8) and rates of asymptomatic ICH (OR = 2.40; 95% CI: 0.89-6.5).

Conclusions

Risks of ICH after thrombolysis for acute ischemic stroke are similar in patients over and under 80 years of age. Our data suggest that the decision to provide thrombolytic therapy should not be solely based on patient's age.

Section snippets

Patients

We selected patients from the Brain Attack Database at University Hospitals of Cleveland, Ohio. This database was prospectively collected between October 1993 and May 2006 and contained information on evaluation and treatment of all patients with symptoms suggestive of acute stroke. Written informed consent for data collection was obtained from patients or from their next of kin at the time of initial interview. For hypothesis analysis we selected patients who received thrombolytic therapy with

Demographics

We analyzed data from 488 patients who were treated with thrombolytic therapy for acute ischemic stroke. Patient population characteristics are summarized in Table 1. There were significantly more women in the older cohort of patients, which could be a result of increased prevalence of acute ischemic stroke in older women. Older patients were more likely to have a diagnosis of hypertension and less likely to smoke. There was also a greater percent of younger patients who received urokinase.

Population Characteristics

Discussion

Our retrospective analysis of prospectively collected data indicates that older patients do not experience an increased risk of intracranial hemorrhage (ICH) after thrombolytic therapy. We evaluated outcomes for elderly patients not only after IV thrombolysis within 3 hours but also after IV/IA or IA therapy up to 6 hours from the onset of symptoms. The results of our analysis indicate that there is no age-dependent association of symptomatic hemorrhage with IV, IV/IA, or IA therapies.

As shown

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