Engelter Stefan T, Bonati Leo H, Lyrer Philippe A
Department of Neurology, University Hospital Basel, Basel, Switzerland.
Age Ageing. 2006 Nov;35(6):572-80. doi: 10.1093/ageing/afl104.
elderly stroke patients were excluded or underrepresented in the randomised controlled trials of intravenous thrombolysis with recombinant tissue plasminogen activator (rtPA) applied within 3 h. Cohort studies comparing intravenous rtPA in stroke patients of >/=80 versus <80 years of age were limited by small sample sizes and yielded conflicting results. Thus, we performed a systematic review across all such studies.
a systematic literature search (PubMed; Science Citation Index) was performed to retrieve all eligible studies. Two reviewers independently extracted data on 'death', 'favourable 3-month outcome (modified Rankin Scale </=1)' and 'symptomatic intracranial haemorrhage (sICH)'. Across studies, weighted odds ratios (ORs) with 95% confidence intervals (95% CI) were calculated.
six studies were included [n = 2,244 patients; 477 (21%) aged >/=80 years]. Significant differences in baseline characteristics to the disadvantage of older patients were present in all studies. Compared with younger patients, older patients had a 3.09-time (95% CI = 2.37-4.03; P < 0.001) higher 3-month mortality and were less likely to regain a 'favourable outcome' (OR = 0.53; 95% CI = 0.42-0.66; P<0.001). The likelihood for 'sICH' (OR = 1.22; 95% CI = 0.77-1.94; P = 0.34) was similar in both age groups.
intravenous rtPA-treated stroke patients of >/=80 years of age have a less favourable outcome than younger ones. Imbalances in predictive baseline variables to the disadvantage of the older patients may contribute to this finding. Compared with the younger cohort, rtPA-treated stroke patients aged >/=80 years do not seem exceedingly prone to sICH. Thus, there is scope for benefit from thrombolysis for the older age group. Hence, to obtain reliable evidence on the balance of risk and benefit of intravenous rtPA for stroke patients aged >/=80 years, it is safe and reasonable to include such patients in randomised placebo-controlled trials.
在重组组织型纤溶酶原激活剂（rtPA）3小时内静脉溶栓的随机对照试验中，老年中风患者被排除在外或所占比例过低。比较≥80岁与＜80岁中风患者静脉使用rtPA的队列研究因样本量小而受限，且结果相互矛盾。因此，我们对所有此类研究进行了系统评价。
进行系统文献检索（PubMed；科学引文索引）以检索所有符合条件的研究。两名评价者独立提取关于“死亡”、“3个月良好结局（改良Rankin量表≤1）”和“症状性颅内出血（sICH）”的数据。在各项研究中，计算加权比值比（OR）及95%置信区间（95%CI）。
纳入6项研究[n = 2244例患者；477例（21%）年龄≥80岁]。所有研究中均存在对老年患者不利的基线特征显著差异。与年轻患者相比，老年患者有3个月死亡率高3.09倍（95%CI = 2.37 - 4.03；P < 0.001），且恢复“良好结局”的可能性较小（OR = 0.53；95%CI = 0.42 - 0.66；P < 0.001）。两个年龄组发生“sICH”的可能性相似（OR = 1.22；95%CI = 0.77 - 1.94；P = 0.34）。
≥80岁接受静脉rtPA治疗的中风患者结局不如年轻患者。预测基线变量不利于老年患者的失衡情况可能导致这一结果。与年轻队列相比，≥80岁接受rtPA治疗的中风患者似乎不太容易发生sICH。因此，老年组从溶栓中获益是有可能的。因此，为获得关于≥80岁中风患者静脉rtPA风险和获益平衡的可靠证据，将此类患者纳入随机安慰剂对照试验是安全合理的。
