<p>Cerebral Thrombolysis in Rural Residents Aged ≥ 80</p>

Abstract

The proportion of older people in Poland is higher in rural areas than in urban areas. Thus, we aimed to evaluate treatment rate and factors associated with outcome and safety of intravenous thrombolysis (IVT) in rural residents aged ≥80 years admitted to primary stroke centers. Patients and Methods: This study was a retrospective, observational cohort study of 873 patients treated with recombinant tissue plasminogen activator (rt-PA) in primary stroke centers between February 1, 2009 and December 31, 2017. Among them were 527 rural residents and 231 (26.5%) were ≥80 years of age. The analyses between rural and urban patients aged ≥80 and between rural patients aged <80 and aged ≥80 were performed. Results: The proportion of patients aged ≥80 treated with rt-PA was comparable in rural and urban residents (27.9% vs 24.3% p = 0.24). Rural patients aged ≥80 were also characterized by lower incidence of cardiovascular risk factors and better patients' conditions on admission to hospital. Symptomatic intracerebral hemorrhage rate among ≥80-year-old stroke patients was lower in those living in rural areas than in those living in urban areas (5.4% vs 14.3%, p = 0.02); there were no differences regarding mortality and 3-month functional outcome between both populations. The older group of rural patients was characterized by a higher 3-month mortality (28.5% vs 12.6%, p < 0.001) and lower functional independence rate (34.0% vs 50.5%, p < 0.001) than rural younger patients. Antiplatelet (OR 2.43, 95% CI 1.04-5.66, p = 0.04) and anticoagulant therapy before stroke (OR 3.64, 95% CI 1.21-10.99, p = 0.022), early ischemic changes in baseline computerized tomograprpahy (OR 2.65, 95% CI 1.03-6.82, p = 0.043) were associated with unfavorable outcome; and higher National Institute of Health Stroke Scale score on admission (OR 1.01, 95% CI 1.01-1.20, p = 0.039), higher baseline count of white blood cells (OR 1.33, 95% CI 1.10-0.62, p = 0.003) were associated with mortality in rural patients over 80. Conclusion: We suggest that rural patients aged ≥80 may be safely treated with IVT in routine practice. However, lower efficacy and a higher mortality must be considered in former use of Vitamin K antagonist and antiplatelet or high white blood cells count.

The Impact of Age on Mortality and Disability in Patients With Ischemic Stroke Who Underwent Cerebral Reperfusion Therapy: A Brazilian Cohort Study

“…The data in the present study show a less favorable evolution among elderly people undergoing reperfusion but no increase in mortality rates. Sobolewski et al (2020) suggested that patients aged ≥80 may be safely treated with cerebral reperfusion in routine practice. The results of this Latin American cohort study also reaffirm the benefits of thrombolytic therapy for stroke patients in this age group.…”

“…Sobolewski et al ( 2020 ) suggested that patients aged ≥80 may be safely treated with cerebral reperfusion in routine practice. The results of this Latin American cohort study also reaffirm the benefits of thrombolytic therapy for stroke patients in this age group.…”

Prognostic significance of age in patients with acute ischaemic stroke treated with intravenous thrombolysis

“…Patients aged 80 or more who had mRS 3-6 90 days after stroke onset (n = 53) compared to those with favourable outcome (n = 49) had higher NIHSS score on admission (16 [14-20] vs. 7 [5][6][7][8][9][10][11][12], p < 0.001) and after IVT (15 [8][9][10][11][12][13][14][15][16][17][18] vs. 2 [1-6], p < 0.001), more often had haemorrhagic brain complications after IVT (35.85% vs. 8.16%, p < 0.001) and premorbid disability (pre-stroke mRS score ≥ 1: 28.30% vs. 8.16%, p = 0.010), less often had fasting glucose level below 5.5 mmol/L (9.43% vs. 26.53%, p = 0.023), had higher CRP levels (27.2 [9.1-84.1] vs. 4.3 [2.1-10.3] mg/L, p < 0.001), and had higher maximal diastolic blood pressure within 24 hours after IVT (80 [72-90] vs. 80 [70-85] mmHg, p = 0.026) (Supplemental Tab. 1).…”

“…1). Patients below 60 who had mRS 3-6 90 days after stroke onset (n = 10) compared to those with a favourable outcome (n = 59) more often suffered from hypertension (90.00% vs. 54.24%, p = 0.033), more often underwent MT (90.00% vs. 38.98%, p = 0.028), had higher NIHSS score on admission (19 [18-20] vs. 9 [5][6][7][8][9][10][11][12][13][14][15][16], p = 0.005) and after IVT (19 [15][16][17][18][19] vs. 4 [2][3][4][5][6][7][8], p < 0.001), more often had haemorrhagic brain complications after IVT (70.00% vs. 14.56%, p < 0.001), and had higher CRP levels (9.3 [7.2-14.0] vs. 4.0 [1.5-7.7] mg/L, p = 0.018) (Supplemental Tab. 1).…”

“…Patients aged 80 or more who had mRS 3-6 90 days after stroke onset (n = 13) compared to those with a favourable outcome (n = 6) had a higher NIHSS score after IVT (15 [8][9][10][11][12][13][14][15][16][17][18][19] vs. 4 [2-10], p = 0.018) (Supplemental Tab. 4).…”