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

Age and Ageing

Volumn 33, Issue 2, 2004, Pages 143-149

  Simon, Jessica E ^a,d   Sandler, David L ^a,b   Pexman, J H Warwick ^a   Hill, Michael D ^a,c   Buchan, Alastair M ^a  

^a UNIVERSITY OF CALGARY   (Canada)

^b BIRMINGHAM HEARTLANDS HOSPITAL   (United Kingdom)

^c UNIVERSITY OF CALGARY   (Canada)

^d FOOTHILLS HOSPITAL   (Canada)

Author keywords

80 and over; Acute stroke; Aged; Elderly; Thrombolytic therapy

Indexed keywords

ALTEPLASE; ANTITHROMBOCYTIC AGENT; HEPARIN;

AGED; ANGIONEUROTIC EDEMA; BLEEDING; BRAIN HEMORRHAGE; BRAIN INFARCTION; CANADA; CEREBROVASCULAR ACCIDENT; CLINICAL EXAMINATION; CONTROLLED STUDY; DEATH; DEMOGRAPHY; DISEASE COURSE; DISEASE SEVERITY; DRUG FATALITY; DRUG SAFETY; FEMALE; FIBRINOLYTIC THERAPY; FUNCTIONAL ASSESSMENT; HOSPITAL ADMISSION; HOSPITAL DISCHARGE; HUMAN; INFORMATION PROCESSING; MALE; MORTALITY; OUTCOMES RESEARCH; PRIORITY JOURNAL; PROSPECTIVE STUDY; REVIEW; SCORING SYSTEM; STATISTICAL SIGNIFICANCE; SURVIVAL; SYMPTOMATOLOGY;

AGED; AGED, 80 AND OVER; AGING; CEREBROVASCULAR ACCIDENT; FEMALE; FIBRINOLYTIC AGENTS; HUMANS; INJECTIONS, INTRAVENOUS; MALE; PROSPECTIVE STUDIES; RETROSPECTIVE STUDIES; SURVIVAL ANALYSIS; THROMBOLYTIC THERAPY; TISSUE PLASMINOGEN ACTIVATOR; TREATMENT OUTCOME;

EID: 1542329658     PISSN: 00020729     EISSN: None     Source Type: Journal    
DOI: 10.1093/ageing/afh031     Document Type: Review

References (33)

1. Brown RD, Whisnant JP, Sicks JD et al. Stroke incidence, prevalence and survival: secular trends in Rochester, Minnesota, through 1989. Stroke 1996; 27: 373-80.
2. Dennis MS, Burn JP, Sandercock PA et al. Long-term survival after first-ever stroke: the Oxfordshire Community Stroke Project. Stroke 1993; 24: 796-800.
3. Sharma JC, Fletcher S, Vassallo M. Strokes in the elderly-higher acute and 3-month mortality- an explanation. Cerebrovasc Dis 1999; 9: 2-9.
4. The NINDS rt-PA Stroke Study Group. Tissue plasminogen activator for acute ischemic stroke. N Engl J Med 1995; 333; 1581-7.
5. Wardlaw JM, del Zoppo G, Yamaguchi T. Thrombolysis for acute ischaemic stroke. Cochrane Database Syst Rev 2000; 2: CD000213.
6. Lindley RI. Thrombolysis for acute stroke in the United Kingdom. Age Ageing 2002; 31 (Suppl. 3): 28-30.
7. Hacke W, Kaste M, Fieschi C et al. for the ECASS study group. Intravenous thrombolysis with recombinant tissue plasminogen activator for acute hemispheric stroke. The European Cooperative Acute Stroke Study (ECASS). JAMA 1995; 274: 1017-25.
8. Hacke W, Kaste M, Fieschi C et al. for the second European-Australasian Acute Stroke Study investigators. Randomised double-blind placebo-controlled trial of thrombolytic therapy with intravenous alteplase in acute ischaemic stroke (ECASS II). Lancet 1998; 352: 1245-51.
9. Clark WM, Wissman S, Albers GW et al. Recombinant tissue-type plasminogen activator (Alteplase) for ischemic stroke 3 to 5 hours after symptom onset. The ATLANTIS Study: a randomized controlled trial. Alteplase Thrombolysis for Acute Noninterventional Therapy in Ischemic Stroke. JAMA 1999; 282: 2019-26.
10. Albers GW, Clark WM, Madden KP, Hamilton SA. ATLANTIS trial: results for patients treated within 3 hours of stroke onset. Stroke 2002; 33: 493-95.
11. Rothwell PM. Carotid endarterectomy and prevention of stroke in the very elderly. Lancet 2001; 357: 1142-3.
12. Hill MD, Barber PA, Demchuk AM et al. Building a "brain attack" team to administer thrombolytic therapy for acute ischemic stroke. CMAJ 2000; 162: 1589-93.
13. Norris JW, Buchan A, Cote R et al. Canadian guidelines for intravenous thrombolytic treatment in acute stroke. A consensus statement of the Canadian Stroke Consortium. Can J Neurol Sci 1998; 25: 257-9.
14. Lyden P, Brott T, Tilley B et al. Improved reliability of the NIH stroke scale using video training. NINDS TPA Stroke Study Group. Stroke 1994; 25: 2220-6.
15. van Swieten JC, Koudstaal PJ, Visser MC, Schouten HJ, van Gijn J. Interobserver agreement for the assessment of handicap in stroke patients. Stroke 1988; 19: 604-7.
16. Pexman JHW, Barber PA, Hill MD et al. Use of the Alberta Stroke Program Early CT Score (ASPECTS) for assessing CT scans in patients with acute stroke. AJNR Am J Neuroradiol 2001; 22: 1534-42.
17. Barber PA, Demchuk AM, Zhang J, Buchan AM for the ASPECTS Study Group. Validity and reliability of a quantitative computed tomography score in predicting outcome of hyperacute stroke before thrombolytic therapy. Lancet 2000; 355: 1670-4.
18. Furlan A, Higashida R, Wechsler L et al. Intra-arterial prourokinase for acute ischemic stroke. The PROACT II Study: a randomized controlled trial (Prolyse in Acute Cerebral Thromboembolism). JAMA 1999; 282: 2003-11.
19. Lee J. Covariance adjustment of rates based on the multiple logistic regression model. J. Chronic Dis 1981; 34: 415-26.
20. Hill MD, Barber PA, Takahashi J, Demchuk AM, Feasby TE, Buchan AM. Anaphylactoid reactions and angioedema during alteplase treatment of acute ischemic stroke. CMAJ 2000; 162: 1281-4.
21. Barber PA, Zhang J, Demchuk AM, Hill MD, Buchan AM. Why are stroke patients excluded from t-PA therapy? An analysis of patient eligibility. Neurology 2001; 56: 1015-20.
22. Tanne D, Gorman MJ, Bates VE et al. Intravenous tissue plasminogen activator for acute ischemic stroke in patients aged 80 years and older. The tPA stroke survey experience. Stroke 2000; 31: 370-5.
23. Buchan AM, Barber PA, Newcommon N et al. Effectiveness of t-PA in acute ischemic stroke: Outcome relates to appropriateness. Neurology 2000; 54: 679-84.
24. Di Carlo A, Lamassa M, Pracucci G et al. for the European BIOMED study of stroke care group. Stroke in the very old - Clinical presentation and determinants of 3-month functional outcome: a European perspective. Stroke 1999; 30: 2313-19.
25. Arboix A, Garcia-Eroles L, Massons J, Oliveres M, Targa C. Acute stroke in very old people: Clinical features and predictors of in-hospital mortality. J Am Geriatr Soc 2000: 48; 36-41.
26. Mayo NE, Neville D, Kirkland S et al. Hospitalization and case-fatality rates for stroke in Canada from 1982 through 1991: the Canadian Collaborative Study Group of Stroke Hospitalizations. Stroke 1996; 27: 1215-20.
27. Tanne D, Kasner SE, Demchuk AM et al. Markers of increased risk of intracerebral hemorrhage after intravenous recombinant tissue plasminogen activator therapy for acute ischemic stroke in clinical practice: the Multicenter rt-PA Acute Stroke Survey. Circulation 2002; 105: 1679-85.
28. Demchuk AM, Tanne D, Hill MD et al. Predictors of good outcome after intravenous tPA for acute ischemic stroke. Neurology 2001; 57: 474-80.
29. Larrue V, von Kummer R, Müller A, Bluhmki E. Risk factors for severe hemorrhagic transformation in ischemic stroke patients treated with recombinant tissue plasminogen activator. A secondary analysis of the European-Australasian Acute Stroke Study (ECASSII). Stroke 2001; 32: 438-41.
30. The NINDS t-PA stroke Study Group. Generalised efficacy of t-PA for acute stroke. Subgroup analysis of the NINDS t-PA Stroke Trial. Stroke 1997; 28: 2119-25.
31. Segal JB, McNamara RL, Miller MR et al. Anticoagulants or antiplatelet therapy for non-rheumatic atrial fibrillation and flutter. Cochrane Database Syst Rev 2001; 1: CD001938.
32. Selim M, Fink JN, Kumar S et al. Predictors of hemorrhagic transformation after intravenous recombinant tissue plasminogen activator: prognostic value of the initial apparent diffusion coefficient and diffusion-weighted lesion volume. Stroke 2002; 33: 2047-52.
33. http://www.dcn.ed.ac.uk/ist3/. Accessed January 2003.