Tanne D, Gorman M J, Bates V E, Kasner S E, Scott P, Verro P, Binder J R, Dayno J M, Schultz L R, Levine S R
Departments of Neurology, Henry Ford Health Science Center, Detroit, MI, USA.
Stroke. 2000 Feb;31(2):370-5. doi: 10.1161/01.str.31.2.370.
Intravenous tissue plasminogen activator (tPA) administered within 3 hours of symptom onset is the first available effective therapy for acute ischemic stroke (AIS). Few data exist, however, on its use in very elderly patients. We examined the characteristics, complications, and short-term outcome of AIS patients aged >/=80 years treated with tPA.
Patients aged >/=80 years (n=30) were compared with counterparts aged <80 years (n=159) included in the tPA Stroke Survey, a US retrospective survey of 189 consecutive AIS patients treated with intravenous tPA at 13 hospitals.
Risk of intracerebral hemorrhage (fatal, symptomatic, and total) was 3%, 3%, and 7% in the elderly age group and 2%, 6%, and 9%, respectively, in their younger counterparts (P=NS for all comparisons). Likelihood of favorable outcome, defined as modified Rankin score 0 to 1, National Institutes of Health Stroke Scale score </=5, or marked improvement by hospital discharge, was comparable between groups (37%, 54%, and 43% versus 30%, 54%, and 43%, respectively; P=NS for all comparisons). Elderly patients were more likely to be treated by stroke specialists (87% versus 60%; P=0.005) and less likely to have an identified protocol deviation (13% versus 33%; P=0.03). Elderly patients were discharged more often to nursing care facilities (17% versus 5%; P=0.003). In logistic regression models there were no differences in odds ratio for favorable or poor outcome, other than tendency for higher in-hospital mortality in elderly patients (odds ratio, 2.8; 95% CI, 0.81 to 9.62; P=0.10).
Among AIS patients treated with intravenous tPA, age-related differences in characteristics and disposition were identified. No evidence for withholding tPA treatment for AIS in appropriately selected patients aged >/=80 years was identified.
症状发作3小时内静脉注射组织型纤溶酶原激活剂（tPA）是急性缺血性卒中（AIS）的首个有效治疗方法。然而，关于其在高龄患者中的应用数据较少。我们研究了接受tPA治疗的年龄≥80岁的AIS患者的特征、并发症及短期预后。
将年龄≥80岁的患者（n = 30）与年龄＜80岁的患者（n = 159）进行比较，后者纳入了tPA卒中调查，这是一项对美国13家医院连续189例接受静脉tPA治疗的AIS患者进行的回顾性调查。
老年年龄组颅内出血（致命性、有症状性及总的）风险分别为3%、3%和7%，较年轻患者组分别为2%、6%和9%（所有比较P = 无显著差异）。良好预后的可能性，定义为改良Rankin量表评分为0至1、美国国立卫生研究院卒中量表评分≤5或出院时显著改善，两组之间相当（分别为37%、54%和43%对30%、54%和43%；所有比较P = 无显著差异）。老年患者更有可能由卒中专科医生治疗（87%对60%；P = 0.005），且出现明确方案偏差的可能性较小（13%对33%；P = 0.03）。老年患者出院后更多入住护理机构（17%对5%；P = 0.003）。在逻辑回归模型中，除老年患者住院死亡率有升高趋势外（比值比，2.8；95%可信区间，0.81至9.62；P = 0.10），良好或不良预后的比值比无差异。
在接受静脉tPA治疗的AIS患者中，发现了特征和处置方面与年龄相关的差异。未发现有证据表明在适当选择的年龄≥80岁的患者中应停用tPA治疗AIS。
