Is intravenous recombinant tissue plasminogen activator (rt-PA) safe for use in patients over 80 years old with acute ischaemic stroke? - The Calgary experience

Background: acute ischaemic stroke is common in older people. There is one licensed acute treatment, intravenous recombinant tissue plasminogen activator, but little information is available on its safety in over 80 year olds. Design: review of prospectively collected data on 62 consecutive patients, aged 80 years and over, treated with recombinant tissue plasminogen activator in a tertiary centre. Methods: admission demographic data, clinical and CT stroke severity, symptomatic haemorrhage rate and other complications were compared between patients who were dead at 3 months and those who survived. Discharge location and functional scores outcome were reviewed. The results were compared to those of other studies. Results: the in-hospital death rate was 24.2% and 3 month mortality 32.8%. Patients that died had higher stroke severity scores at presentation (NIHSS 20 versus 16, P=0.04). Six patients (9.7%) suffered symptomatic intracranial haemorrhage (SICH), three were classified as fatal (4.8%). SICH was significantly associated with death by 3 months (P=0.02). There were no other serious bleeding complications. The SICH rate is similar to that from other thrombolytic studies and the mortality rate is similar to the natural history of stroke in older populations. Conclusion: older patients have high mortality and morbidity from stroke. Older patients should not be excluded from recombinant tissue plasminogen activator treatment on the basis of age alone.