Document Detail

Acute stroke management in the elderly.
MedLine Citation:
PMID:  17199089     Owner:  NLM     Status:  MEDLINE    
BACKGROUND AND PURPOSE: Though the proportion of elderly stroke patients is increasing, patients >80 years are often excluded from clinical stroke trials. We reviewed the management of older patients presenting with acute ischemic stroke (AIS) and assessed the safety and efficacy of recombinant tissue plasminogen activator (rtPA) administration in a community-based setting. METHODS: A retrospective review of patients >80 years (n = 341) admitted to a community stroke center with AIS were compared to their younger counterparts (n = 690) using the stroke center database from April 2003 to December 2005. Parameters that were measured included admission and discharge NIH Stroke Scale (NIHSS), rate of thrombolytic treatment, the frequency and etiology of thrombolytic exclusion criteria and complications from rtPA for the different aged populations. Additional data were collected for Barthel Index at 12 months. RESULTS: A total of 166 patients underwent thrombolysis. Older patients were not delayed in reaching the hospital within 3 h of stroke onset (182/690, 26%, in the <80 cohort vs. 98/341, 29%, in the > or = 80 cohort). Although the overall rates of tPA use were similar in both the young and aged cohort, older patients were less likely to be treated with rtPA because of reasons not listed as exclusion criteria (17% in the <80 cohort vs. 32% in the > or = 80 cohort). The older group did not have an excess risk of intracranial hemorrhage following rtPA infusion despite equivalent NIHSS on admission (13.5 in the <80 cohort vs. 12.4 in the > or = 80 cohort). Both groups showed improvement in NIHSS following thrombolytic treatment with a drop of 7.7 points in the younger age group and 5.6 points in the older group. Elderly patients treated with rtPA had a comparable 12-month modified Barthel Index score to younger cohorts. CONCLUSIONS: Early treatment with rtPA in patients >80 years appears to be both safe and efficacious. Treated patients showed improvements both acutely (a decrease in NIHSS at 72 h) and chronically, as shown by a sustained improvement in the Barthel Index. A large number of elderly patients were excluded from rtPA treatment despite arriving within the time frame of treatment for reasons not considered as traditional exclusion criteria. Older patients with AIS can be treated safely with thrombolytic therapy in a community setting. This therapy should not be withheld on the basis of age.
Neer Zeevi; Jyoti Chhabra; Isaac E Silverman; Nora S Lee; Louise D McCullough
Related Documents :
22449449 - Reconstruction of distal urethral strictures confined to the glans with circular buccal...
20222019 - Safety and effectiveness of the invatec proximal cerebral protection device durin...
1488039 - Eeg monitoring of carotid endarterectomy with routine patch-graft angioplasty: an exper...
14606739 - The effect of early aerobic training on independence six months post stroke.
10471419 - The north american symptomatic carotid endarterectomy trial : surgical results in 1415 ...
17872979 - The influence of attention deficits on functional recovery post stroke during the first...
18041389 - The analysis of walk cycle in patients with spastic cerebral palsy after surgical manag...
16781589 - A homeopathic ointment preparation compared with 1% diclofenac gel for acute symptomati...
19968599 - Surgery for knee osteoarthritis in younger patients.
Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, Non-U.S. Gov't     Date:  2006-12-29
Journal Detail:
Title:  Cerebrovascular diseases (Basel, Switzerland)     Volume:  23     ISSN:  1015-9770     ISO Abbreviation:  Cerebrovasc. Dis.     Publication Date:  2007  
Date Detail:
Created Date:  2007-03-14     Completed Date:  2007-04-26     Revised Date:  2009-11-03    
Medline Journal Info:
Nlm Unique ID:  9100851     Medline TA:  Cerebrovasc Dis     Country:  Switzerland    
Other Details:
Languages:  eng     Pagination:  304-8     Citation Subset:  IM    
Copyright Information:
(c) 2007 S. Karger AG, Basel.
Department of Neurology, Hartford Hospital, Hartford, Connecticut, USA.
Export Citation:
APA/MLA Format     Download EndNote     Download BibTex
MeSH Terms
Acute Disease
Age Factors
Aged, 80 and over
Brain Ischemia / complications
Cohort Studies
Community Health Centers / statistics & numerical data
Connecticut / epidemiology
Fibrinolytic Agents / adverse effects,  therapeutic use*
Middle Aged
Patient Selection*
Practice Guidelines as Topic
Recombinant Proteins / therapeutic use
Retrospective Studies
Severity of Illness Index
Stroke / drug therapy*,  epidemiology,  etiology
Thrombolytic Therapy / adverse effects,  statistics & numerical data*
Time Factors
Tissue Plasminogen Activator / adverse effects,  therapeutic use*
Transportation of Patients / statistics & numerical data
Treatment Outcome
Reg. No./Substance:
0/Fibrinolytic Agents; 0/Recombinant Proteins; EC Plasminogen Activator
Comment In:
Cerebrovasc Dis. 2007;24(6):548   [PMID:  18042983 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

Previous Document:  Do extracellular-matrix-regulating enzymes play a role in cervical artery dissection?
Next Document:  sCD40 ligand determined in maternal and umbilical cord blood in pregnancies complicated by pre-eclam...