Thrombolytic therapy for acute ischaemic stroke in octogenarians: Selection by magnetic resonance imaging improves safety but does not improve outcome

Journal of Neurology, Neurosurgery and Psychiatry

Volumn 78, Issue 7, 2007, Pages 690-693

  Ringleb, P A ^a   Schwark, Ch ^a   Kohrmann M ^a   Kulkens S ^a   Juttler E ^a   Hacke, W ^a   Schellinger, P D ^a  

^a UNIVERSITY HOSPITAL HEIDELBERG   (Germany)

Author keywords

[No Author keywords available]

Indexed keywords

FIBRINOLYTIC AGENT;

AGED; ARTICLE; BRAIN HEMORRHAGE; CEREBROVASCULAR ACCIDENT; COMPUTER ASSISTED TOMOGRAPHY; DIFFUSION WEIGHTED IMAGING; DRUG SAFETY; FEMALE; FIBRINOLYTIC THERAPY; HIGH RISK POPULATION; HUMAN; IMAGE ANALYSIS; MAJOR CLINICAL STUDY; MALE; MORBIDITY; MORTALITY; OUTCOME ASSESSMENT; PATIENT SELECTION; PRIORITY JOURNAL; PROSPECTIVE STUDY; RISK ASSESSMENT; RISK BENEFIT ANALYSIS; RISK FACTOR; TREATMENT INDICATION;

ACUTE DISEASE; ADOLESCENT; ADULT; AGE FACTORS; AGED; AGED, 80 AND OVER; BRAIN ISCHEMIA; CEREBRAL HEMORRHAGE; CEREBROVASCULAR ACCIDENT; FEMALE; HUMANS; MAGNETIC RESONANCE IMAGING; MALE; MIDDLE AGED; PATIENT SELECTION; PREDICTIVE VALUE OF TESTS; PROSPECTIVE STUDIES; RISK; THROMBOLYTIC THERAPY; TREATMENT OUTCOME;

EID: 34347225563     PISSN: 00223050     EISSN: 1468330X     Source Type: Journal    
DOI: 10.1136/jnnp.2006.105890     Document Type: Article

References (29)

1. Rothwell PM, Coull AJ, Silver LE, et al. Population-based study of event-rate, incidence, case fatality, and mortality for all acute vascular events in all arterial territories (Oxford Vascular Study). Lancet 2005;366:1773-83.
2. Kammersgaard LP, Jorgensen HS, Reith J, et al. Short- and long-term prognosis for very old stroke patients. The Copenhagen Stroke Study. Age Ageing 2004;33:149-54.
3. 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.
4. Hacke W, Kaste M, Fieschi C, et al. Intravenous thrombolysis with recombinant tissue plasminogen activator for acute stroke. JAMA 1995;274:1017-25.
5. Hacke W, Kaste M, Fieschi C, et al. Randomised double-blind placebo-controlled trial of thrombolytic therapy with intravenous alteplase in acute ischaemic stroke (ECASS II). Lancet 1998;352:1245-51.
6. The National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group. Tissue plasminogen activator for acute ischemic stroke. N Engl J Med 1995;333:1581-7.
7. Ford GA. Thrombolysis for stroke in the over 80s. Age Ageing 2004;33:95-7.
8. The Publications Committee for the Trial of ORG 10172 in Acute Stroke Treatment (TOAST) Investigators. Low molecular weight heparinoid, ORG 10172 (danaparoid), and outcome after acute ischemic stroke: a randomized controlled trial, JAMA 1998;279:1265-72.
9. Hjort N, Butcher K, Davis SM, et al. Magnetic resonance imaging criteria for thrombolysis in acute cerebral infarct. Stroke 2005;36:388-97.
10. NINDS Study Group. Intracerebral hemorrhage after intravenous t-PA therapy for ischemic stroke. Stroke 1997;98:2109-18.
11. Köhrmann M, Jüttler E, Fiebach JB, et al. MRI versus CT-based thrombolysis treatment within and beyond the 3 h time window after stroke onset: a cohort study. Lancet Neurol 2006;5:661-7.
12. Berrouschot J, Rother J, Glahn J, et al. Outcome and severe hemorrhagic complications of intravenous thrombolysis with tissue plasminogen activator in very old (≥80 years) stroke patients. Stroke 2005;36:2421-5.
13. Chen CI, Iguchi Y, Grotta JC, et al. Intravenous TPA for very old stroke patients. Eur Neurol 2005;54:140-4.
14. Engelter ST, Reichhart M, Sekoranja L, et al. Thrombolysis in stroke patients aged 80 years and older: Swiss survey of IV thrombolysis. Neurology 2005;65:1795-8.
15. Mouradian MS, Senthilselvan A, Jickling G, et al. Intravenous rt-PA for acute stroke: comparing its effectiveness in younger and older patients. J Neurol Neurosurg Psychiatry 2005;76:1234-7.
16. Sylaja PN, Cote R, Buchan AM, et al. Thrombolysis for acute ischemic stroke patients aged 80 years and older: Canadian Alteplase for Stroke Effectiveness Study. J Neurol Neurosurg Psychiatry 2006;77:826-9.
17. 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.
18. van Oostenbrugge RJ, Hupperts RM, Lodder J. Thrombolysis for acute stroke with special emphasis on the very old: experience from a single Dutch centre. J Neurol Neurosurg Psychiatry 2006;77:375-7.
19. Parnetti L, Silvestrelli G, Lanari A, et al. Efficacy of thrombolytic (rt-PA) therapy in old stroke patients: the Perugia Stroke Unit experience. Clin Exp Hypertens 2006;28:397-404.
20. Di Carlo A, Lamassa M, Pracucci G, et al. Stroke in the very old: clinical presentation and determinants of 3-month functional outcome: a European perspective. European BIOMED Study of Stroke Care Group. Stroke 1999;30:2313-19.
21. Hacke W, Donnan G, Fieschi C, et al. Association of outcome with early stroke treatment: pooled analysis of ATLANTIS, ECASS, and NINDS rt-PA stroke trials. Lancet 2004;363:768-74.
22. Simon JE, Sandler DL, Pexman JH, et al. 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 Ageing 2004;33:143-9.
23. Hill MD, Buchan AM. Thrombolysis for acute ischemic stroke: results of the Canadian Alteplase for Stroke Effectiveness Study. Can Med Assoc J 2005;172:1307-12.
24. Fiebach J, Jansen O, Schellinger P, et al. Comparison of CT with diffusion-weighted MRI in patients with hyperacute stroke. Neuroradiology 2001;43:628-32.
25. Thomalla G, Schwark C, Sobesky J, et al. Outcome and symptomatic bleeding complications of intravenous thrombolysis within 6 hours in MRI-selected stroke patients: comparison of a German Multicenter Study with the pooled data of ATLANTIS, ECASS, and NINDS tPA trials. Stroke 2006;37:852-8.
26. Rother J, Schellinger PD, Gass A, et al. Effect of intravenous thrombolysis on MRI parameters and functional outcome in acute stroke <6 hours. Stroke 2002;33:2438-45.
27. Ribo M, Molina CA, Rovira A, et al. Safety and efficacy of intravenous tissue plasminogen activator stroke treatment in the 3- to 6-hour window using multimodal transcranial Doppler/MRI selection protocol. Stroke 2005;36:602-6.
28. Kent DM, Price LL, Ringleb P, et al. Sex-based differences in response to recombinant tissue plasminogen activator in acute ischemic stroke: a pooled analysis of randomized clinical trials. Stroke 2005;36:62-5.
29. Lindley RI, Sandercock P. IST-3. 2006; http://www.dcn.ed.ac.uk/ ist3/ (accessed 29 Nov 2006).