J Stroke.  2015 Sep;17(3):327-335. 10.5853/jos.2015.17.3.327.

Intravenous Tissue Plasminogen Activator Improves the Outcome in Very Elderly Korean Patients with Acute Ischemic Stroke

Affiliations
  • 1Department of Neurology, Jeju National University, Jeju, Korea.
  • 2Clinical Research Center, Asan Medical Center, Seoul, Korea.
  • 3Department of Neurology, Seoul Medical Center, Seoul, Korea.
  • 4Department of Neurology, Ilsan Paik Hospital, Inje University, Goyang, Korea. nrhks@paik.ac.kr
  • 5Department of Neurology, Eulji General Hospital, Eulji University, Seoul, Korea.
  • 6Department of Neurology, Soonchunhyang University College of Medicine, Seoul, Korea.
  • 7Department of Neurology, Eulji University Hospital, Daejeon, Korea.
  • 8Department of Neurology, Yeungnam University Hospital, Daegu, Korea.
  • 9Department of Neurology, Chonnam National University Hospital, Gwangju, Korea.
  • 10Department of Neurology, Hallym University Sacred Heart Hospital, Anyang, Korea.
  • 11Department of Neurology, Dong-A University College of Medicine, Busan, Korea.
  • 12Department of Neurology, Dongguk University Ilsan Hospital, Goyang, Korea.
  • 13Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.
  • 14Department of Neurology, Ulsan University Hospital, Ulsan, Korea.
  • 15Department of Neurology, Chungbuk National University Hospital, Cheongju, Korea.
  • 16Department of Neurology, Keimyung University Dongsan Medical Center, Daegu, Korea.
  • 17Department of Biostatistics, Korea University College of Medicine, Seoul, Korea.

Abstract

BACKGROUND AND PURPOSE
In a recent pooled analysis of randomized clinical trials (RCTs), intravenous tissue plasminogen activator (TPA) improves the outcome in patients aged > or =80 years. However, it is uncertain whether the findings are applicable to clinical practice in Asian populations.
METHODS
From a multicenter stroke registry database of Korea, we identified patients with acute ischemic stroke who were aged > or = 80 years. Using multivariable analysis and propensity score (PS)-matched analyses, we assessed the effectiveness and safety of intravenous TPA within 4.5 hours.
RESULTS
Among 2,334 patients who met the eligible criteria, 236 were treated with intravenous TPA (mean age, 83+/-5; median NIHSS, 13 [IQR, 8-17]). At discharge, the TPA group compared to the no-TPA group had a favorable shift on the modified Rankin Scale (mRS) score (multivariable analysis, OR [95% CI], 1.51 [1.17-1.96], P=0.002; PS-matched analysis, 1.54 [1.17-2.04], P=0.002) and was more likely to achieve mRS 0-1 outcome (multivariable analysis, 2.00 [1.32-3.03], P=0.001; PS-matched analysis, 1.59 [1.04-2.42], P=0.032). TPA treatment was associated with an increased risk of symptomatic intracranial hemorrhage (multivariable analysis, 5.45 [2.80-10.59], P<0.001; PS-matched analysis, 4.52 [2.24-9.13], P<0.001), but did not increase the in-hospital mortality (multivariable analysis, 0.86 [0.50-1.48], P=0.58; PS-matched analysis, 0.88 [0.52-1.47], P=0.61).
CONCLUSIONS
In the setting of clinical practice, intravenous TPA within 4.5 hours improved the functional outcome despite an increased risk of symptomatic intracranial hemorrhage in very elderly Korean patients. The findings, consistent with those from pooled analysis of RCTs, strongly support the use of TPA for this population.

Keyword

Elderly; Ischemic stroke; Thrombolytic therapy; Outcome assessment

MeSH Terms

Aged*
Asian Continental Ancestry Group
Hospital Mortality
Humans
Intracranial Hemorrhages
Korea
Propensity Score
Stroke*
Thrombolytic Therapy
Tissue Plasminogen Activator*
Tissue Plasminogen Activator
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