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 NahDong 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

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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.

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

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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., Kang, K., Lee, K. B., Lee, S. J., Ko, Y., Kim, J. G., Lee, J., Cho, K. H., Kim, J. T., Yu, K. H., Lee, B. C., Oh, M. S., Cha, J. K., Kim, D. H., ... 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