The Factors Associated with the Decision of r-tPA Use in Acute Ischemic Stroke Patients Aged 80 Years or Older.
- Author:
Min Gyeong JEONG
1
;
Yerim KIM
;
Yeo Jin KIM
;
Mi Sun OH
;
Kyung Ho YU
;
Byung Chul LEE
;
Ju Hun LEE
;
Jee Hyun KWON
;
Sun Uck KWON
;
Sung Hyuk HEO
;
Jay Chol CHOI
;
Hyung Min KWON
;
Jong Moo PARK
;
Eung Gyu KIM
;
Joung Ho RHA
;
Hee Kwon PARK
;
Hee Joon BAE
;
Moon Ku HAN
;
Keun Sik HONG
;
Yong Jin CHO
;
Man Seok PARK
;
Ki Hyun CHO
;
Hahn Young KIM
;
Jun LEE
;
Dong Eog KIM
;
Soo Joo LEE
;
Kyung Bok LEE
;
Tai Hwan PARK
;
Myoung Jin CHA
;
Ji Hoe HEO
;
Hyo Suk NAM
;
Jae Kwan CHA
;
Chul Ho KIM
;
Byung Woo YOON
Author Information
1. Department of Neurology, Hallym University College of Medicine, Anyang, Korea. ssbrain@hallym.ac.kr
- Publication Type:Original Article
- Keywords:
Stroke;
Thrombolysis;
Tissue plasminogen activation;
Elderly;
Exclusion
- MeSH:
Aged;
Hospitals, University;
Humans;
National Institute of Neurological Disorders and Stroke;
Registries;
Stroke;
Thrombolytic Therapy;
Tissue Plasminogen Activator
- From:Korean Journal of Stroke
2011;13(2):79-84
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
BACKGROUND: Small proportions of all the elderly stroke patients receive recombinant tissue plasminogen activator (r-tPA) therapy, although old age is not a proven contraindication to intravenous thrombolytic therapy for acute ischemic stroke. The purpose of this study was to identify reasons for exclusion from r-tPA therapy and factors associated with the decision of r-tPA use in elderly patients with acute ischemic stroke. METHODS: From the acute stroke registries of 22 domestic university hospitals taking the r-tPA therapy from January 2007 to May 2010, we extracted data of all acute ischemic stroke patients who were aged 80 or over and arrived within onset 3 hours. For all patients, we assessed the eligibility of r-tPA therapy using National Institute of Neurological Disorders and Stroke (NINDS) r-tPA trial criteria. For eligible patients, we compared all clinical variables between patients who were treated with r-tPA and those who were not, and analyzed potential factors related to the decision of r-tPA use. RESULTS: A total of 494 patients were included in this study. 255 patients (51.6%) were excluded by NINDS r-tPA trial criteria and the major reasons for exclusion were minor neurological deficit (53.7%) and clinical improvement (17.3%). Among 239 patients who were eligible for r-tPA, 162 (32.8%) patients received r-tPA and 77 (15.6%) did not. Multivariable analysis showed that younger age, shorter time-delay from onset to admission, non-smoker, no history of prior stroke, good pre-stroke functional status and severe initial neurological deficit were independently associated with the decision of r-tPA use in the elderly stroke patients predictors for r-tPA treatment. CONCLUSION: In very elderly patients, mild neurological deficit on arrival and rapid clinical improvement in neurological symptoms were the main reasons for exclusion from thrombolytic therapy.
