Objectives: This retrospective single-center study aimed to investigate the risk factors,
outcomes and complication rates in patients older vs. younger than 80 years treated
with intravenous alteplase.
Methods: Data of 1,253 thrombolysed patients were analyzed between January 1, 2004
and August 31, 2016. Vascular risk factors, stroke severity based on the NIHSS score,
functional outcome using modified Rankin Scale (mRS), mortality and symptomatic intracerebral
hemorrhage (SICH) were compared between two subgroups (<80 and >= 80 years).
Results: 1,125 patients were included, 199 (17.6%) among them were aged over 80 years,
majority (63.3%) were female (p < 0.00001). Mean age was 68.2 +/- 12.4 years, i.e.,
64.7 +/- 10.8 years and 84.3 +/- 3.4 years in the younger and the older groups, respectively
(p < 0.001). Atrial fibrillation and pre-stroke anticoagulation among patients over
80 years was more likely (p < 0.0005 and p = 0.02, respectively). NIHSS scores on
admission and at 24 h were higher in elderly patients (p < 0.0001). ASPECT score at
24 h was less favorable in elderly patients (p = 0.007) and was associated with worse
outcome. At 3 months, 59.8% of the patients from the older group had an unfavorable
outcome (p < 0.0001), however 34.7% had independent outcome. The one-year- survival
was significantly worse in the older group (p < 0.0001). The incidence of SICH was
lower among older patients. In a logistic regression model, atrial fibrillation, heart
failure, diabetes mellitus and smoking were proven as a significant independent risk
factors for worse outcome.
Conclusion: Although, the outcomes were less favorable in patients over 80 years of
age, our results support the feasibility of using intravenous thrombolysis among patients
over 80 years of age.
