Intravenous tissue plasminogen activator improves the outcome in very elderly Korean patients with acute ischemic stroke

Jay Chol Choi, Ji Sung Lee, Tai Hwan Park, Sang Soon Park, Yong Jin Cho, Jong Moo Park, Kyusik Kang, Kyung Bok Lee, Soo Joo Lee, Youngchai Ko, Jae Guk Kim, Jun Lee, Ki Hyun Cho, Joon Tae Kim, Kyung Ho Yu, Byung Chul Lee, Mi Sun Oh, Jae Kwan Cha, Dae Hyun Kim, Hyun Wook Nah & 11 others Dong Eog Kim, Wi Sun Ryu, Beom Joon Kim, Hee Joon Bae, Wook Joo Kim, Dong Ick Shin, Min Ju Yeo, Sung Il Sohn, Jeong Ho Hong, Juneyoung Lee, Keun Sik Hong

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Background and Purpose In a recent pooled analysis of randomized clinical trials (RCTs), intravenous tissue plasminogen activator (TPA) improves the outcome in patients aged ≥80 years. However, it is uncertain whether the findings are applicable to clinical practice in Asian populations. Methods From a multicenter stroke registry database of Korea, we identified patients with acute ischemic stroke who were aged ≥80 years. Using multivariable analysis and propensity score (PS)-matched analyses, we assessed the effectiveness and safety of intravenous TPA within 4.5 hours. Results Among 2,334 patients who met the eligible criteria, 236 were treated with intravenous TPA (mean age, 83±5; median NIHSS, 13 [IQR, 8-17]). At discharge, the TPA group compared to the no-TPA group had a favorable shift on the modified Rankin Scale (mRS) score (multivariable analysis, OR [95% CI], 1.51 [1.17-1.96], P=0.002; PS-matched analysis, 1.54 [1.17-2.04], P=0.002) and was more likely to achieve mRS 0-1 outcome (multivariable analysis, 2.00 [1.32-3.03], P=0.001; PS-matched analysis, 1.59 [1.04-2.42], P=0.032). TPA treatment was associated with an increased risk of symptomatic intracranial hemorrhage (multivariable analysis, 5.45 [2.80-10.59], P<0.001; PS-matched analysis, 4.52 [2.24-9.13], P<0.001), but did not increase the creatiin- hospital mortality (multivariable analysis, 0.86 [0.50-1.48], P=0.58; PS-matched analysis, 0.88 [0.52-1.47], P=0.61). Conclusions In the setting of clinical practice, intravenous TPA within 4.5 hours improved the functional outcome despite an increased risk of symptomatic intracranial hemorrhage in very elderly Korean patients. The findings, consistent with those from pooled analysis of RCTs, strongly support the use of TPA for this population.

Original languageEnglish
Pages (from-to)327-335
Number of pages9
JournalJournal of Stroke
Volume17
Issue number3
DOIs
Publication statusPublished - 2015 Sep 1

Fingerprint

Tissue Plasminogen Activator
Propensity Score
Stroke
Intracranial Hemorrhages
Randomized Controlled Trials
Korea
Hospital Mortality
Population
Registries
Databases
Safety

Keywords

  • Elderly
  • Ischemic stroke
  • Outcome assessment
  • Thrombolytic therapy

ASJC Scopus subject areas

  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine

Cite this

Choi, J. C., Lee, J. S., Park, T. H., Park, S. S., Cho, Y. J., Park, J. M., ... Hong, K. S. (2015). Intravenous tissue plasminogen activator improves the outcome in very elderly Korean patients with acute ischemic stroke. Journal of Stroke, 17(3), 327-335. https://doi.org/10.5853/jos.2015.17.3.327

Intravenous tissue plasminogen activator improves the outcome in very elderly Korean patients with acute ischemic stroke. / Choi, Jay Chol; Lee, Ji Sung; Park, Tai Hwan; Park, Sang Soon; Cho, Yong Jin; Park, Jong Moo; Kang, Kyusik; Lee, Kyung Bok; Lee, Soo Joo; Ko, Youngchai; Kim, Jae Guk; Lee, Jun; Cho, Ki Hyun; Kim, Joon Tae; Yu, Kyung Ho; Lee, Byung Chul; Oh, Mi Sun; Cha, Jae Kwan; Kim, Dae Hyun; Nah, Hyun Wook; Kim, Dong Eog; Ryu, Wi Sun; Kim, Beom Joon; Bae, Hee Joon; Kim, Wook Joo; Shin, Dong Ick; Yeo, Min Ju; Sohn, Sung Il; Hong, Jeong Ho; Lee, Juneyoung; Hong, Keun Sik.

In: Journal of Stroke, Vol. 17, No. 3, 01.09.2015, p. 327-335.

Research output: Contribution to journalArticle

Choi, JC, Lee, JS, Park, TH, Park, SS, Cho, YJ, Park, JM, Kang, K, Lee, KB, Lee, SJ, Ko, Y, Kim, JG, Lee, J, Cho, KH, Kim, JT, Yu, KH, Lee, BC, Oh, MS, Cha, JK, Kim, DH, Nah, HW, Kim, DE, Ryu, WS, Kim, BJ, Bae, HJ, Kim, WJ, Shin, DI, Yeo, MJ, Sohn, SI, Hong, JH, Lee, J & Hong, KS 2015, 'Intravenous tissue plasminogen activator improves the outcome in very elderly Korean patients with acute ischemic stroke', Journal of Stroke, vol. 17, no. 3, pp. 327-335. https://doi.org/10.5853/jos.2015.17.3.327
Choi, Jay Chol ; Lee, Ji Sung ; Park, Tai Hwan ; Park, Sang Soon ; Cho, Yong Jin ; Park, Jong Moo ; Kang, Kyusik ; Lee, Kyung Bok ; Lee, Soo Joo ; Ko, Youngchai ; Kim, Jae Guk ; Lee, Jun ; Cho, Ki Hyun ; Kim, Joon Tae ; Yu, Kyung Ho ; Lee, Byung Chul ; Oh, Mi Sun ; Cha, Jae Kwan ; Kim, Dae Hyun ; Nah, Hyun Wook ; Kim, Dong Eog ; Ryu, Wi Sun ; Kim, Beom Joon ; Bae, Hee Joon ; Kim, Wook Joo ; Shin, Dong Ick ; Yeo, Min Ju ; Sohn, Sung Il ; Hong, Jeong Ho ; Lee, Juneyoung ; Hong, Keun Sik. / Intravenous tissue plasminogen activator improves the outcome in very elderly Korean patients with acute ischemic stroke. In: Journal of Stroke. 2015 ; Vol. 17, No. 3. pp. 327-335.
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abstract = "Background and Purpose In a recent pooled analysis of randomized clinical trials (RCTs), intravenous tissue plasminogen activator (TPA) improves the outcome in patients aged ≥80 years. However, it is uncertain whether the findings are applicable to clinical practice in Asian populations. Methods From a multicenter stroke registry database of Korea, we identified patients with acute ischemic stroke who were aged ≥80 years. Using multivariable analysis and propensity score (PS)-matched analyses, we assessed the effectiveness and safety of intravenous TPA within 4.5 hours. Results Among 2,334 patients who met the eligible criteria, 236 were treated with intravenous TPA (mean age, 83±5; median NIHSS, 13 [IQR, 8-17]). At discharge, the TPA group compared to the no-TPA group had a favorable shift on the modified Rankin Scale (mRS) score (multivariable analysis, OR [95{\%} CI], 1.51 [1.17-1.96], P=0.002; PS-matched analysis, 1.54 [1.17-2.04], P=0.002) and was more likely to achieve mRS 0-1 outcome (multivariable analysis, 2.00 [1.32-3.03], P=0.001; PS-matched analysis, 1.59 [1.04-2.42], P=0.032). TPA treatment was associated with an increased risk of symptomatic intracranial hemorrhage (multivariable analysis, 5.45 [2.80-10.59], P<0.001; PS-matched analysis, 4.52 [2.24-9.13], P<0.001), but did not increase the creatiin- hospital mortality (multivariable analysis, 0.86 [0.50-1.48], P=0.58; PS-matched analysis, 0.88 [0.52-1.47], P=0.61). Conclusions In the setting of clinical practice, intravenous TPA within 4.5 hours improved the functional outcome despite an increased risk of symptomatic intracranial hemorrhage in very elderly Korean patients. The findings, consistent with those from pooled analysis of RCTs, strongly support the use of TPA for this population.",
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T1 - Intravenous tissue plasminogen activator improves the outcome in very elderly Korean patients with acute ischemic stroke

AU - Choi, Jay Chol

AU - Lee, Ji Sung

AU - Park, Tai Hwan

AU - Park, Sang Soon

AU - Cho, Yong Jin

AU - Park, Jong Moo

AU - Kang, Kyusik

AU - Lee, Kyung Bok

AU - Lee, Soo Joo

AU - Ko, Youngchai

AU - Kim, Jae Guk

AU - Lee, Jun

AU - Cho, Ki Hyun

AU - Kim, Joon Tae

AU - Yu, Kyung Ho

AU - Lee, Byung Chul

AU - Oh, Mi Sun

AU - Cha, Jae Kwan

AU - Kim, Dae Hyun

AU - Nah, Hyun Wook

AU - Kim, Dong Eog

AU - Ryu, Wi Sun

AU - Kim, Beom Joon

AU - Bae, Hee Joon

AU - Kim, Wook Joo

AU - Shin, Dong Ick

AU - Yeo, Min Ju

AU - Sohn, Sung Il

AU - Hong, Jeong Ho

AU - Lee, Juneyoung

AU - Hong, Keun Sik

PY - 2015/9/1

Y1 - 2015/9/1

N2 - Background and Purpose In a recent pooled analysis of randomized clinical trials (RCTs), intravenous tissue plasminogen activator (TPA) improves the outcome in patients aged ≥80 years. However, it is uncertain whether the findings are applicable to clinical practice in Asian populations. Methods From a multicenter stroke registry database of Korea, we identified patients with acute ischemic stroke who were aged ≥80 years. Using multivariable analysis and propensity score (PS)-matched analyses, we assessed the effectiveness and safety of intravenous TPA within 4.5 hours. Results Among 2,334 patients who met the eligible criteria, 236 were treated with intravenous TPA (mean age, 83±5; median NIHSS, 13 [IQR, 8-17]). At discharge, the TPA group compared to the no-TPA group had a favorable shift on the modified Rankin Scale (mRS) score (multivariable analysis, OR [95% CI], 1.51 [1.17-1.96], P=0.002; PS-matched analysis, 1.54 [1.17-2.04], P=0.002) and was more likely to achieve mRS 0-1 outcome (multivariable analysis, 2.00 [1.32-3.03], P=0.001; PS-matched analysis, 1.59 [1.04-2.42], P=0.032). TPA treatment was associated with an increased risk of symptomatic intracranial hemorrhage (multivariable analysis, 5.45 [2.80-10.59], P<0.001; PS-matched analysis, 4.52 [2.24-9.13], P<0.001), but did not increase the creatiin- hospital mortality (multivariable analysis, 0.86 [0.50-1.48], P=0.58; PS-matched analysis, 0.88 [0.52-1.47], P=0.61). Conclusions In the setting of clinical practice, intravenous TPA within 4.5 hours improved the functional outcome despite an increased risk of symptomatic intracranial hemorrhage in very elderly Korean patients. The findings, consistent with those from pooled analysis of RCTs, strongly support the use of TPA for this population.

AB - Background and Purpose In a recent pooled analysis of randomized clinical trials (RCTs), intravenous tissue plasminogen activator (TPA) improves the outcome in patients aged ≥80 years. However, it is uncertain whether the findings are applicable to clinical practice in Asian populations. Methods From a multicenter stroke registry database of Korea, we identified patients with acute ischemic stroke who were aged ≥80 years. Using multivariable analysis and propensity score (PS)-matched analyses, we assessed the effectiveness and safety of intravenous TPA within 4.5 hours. Results Among 2,334 patients who met the eligible criteria, 236 were treated with intravenous TPA (mean age, 83±5; median NIHSS, 13 [IQR, 8-17]). At discharge, the TPA group compared to the no-TPA group had a favorable shift on the modified Rankin Scale (mRS) score (multivariable analysis, OR [95% CI], 1.51 [1.17-1.96], P=0.002; PS-matched analysis, 1.54 [1.17-2.04], P=0.002) and was more likely to achieve mRS 0-1 outcome (multivariable analysis, 2.00 [1.32-3.03], P=0.001; PS-matched analysis, 1.59 [1.04-2.42], P=0.032). TPA treatment was associated with an increased risk of symptomatic intracranial hemorrhage (multivariable analysis, 5.45 [2.80-10.59], P<0.001; PS-matched analysis, 4.52 [2.24-9.13], P<0.001), but did not increase the creatiin- hospital mortality (multivariable analysis, 0.86 [0.50-1.48], P=0.58; PS-matched analysis, 0.88 [0.52-1.47], P=0.61). Conclusions In the setting of clinical practice, intravenous TPA within 4.5 hours improved the functional outcome despite an increased risk of symptomatic intracranial hemorrhage in very elderly Korean patients. The findings, consistent with those from pooled analysis of RCTs, strongly support the use of TPA for this population.

KW - Elderly

KW - Ischemic stroke

KW - Outcome assessment

KW - Thrombolytic therapy

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