Key result
Alteplase linked to ~46% more good functional outcomes vs control in acute ischemic stroke patients over 80.
Why the study?
Expert guidelines set no upper age limit for alteplase in acute ischemic stroke, but European regulatory criteria previously restricted use to patients aged 18 to 80 years.
Does alteplase improve functional outcomes in patients aged >80 years with acute ischemic stroke?
Population
Patients with acute ischemic stroke from 7 RCTs and the SITS-UTMOST registry
Comparison
Alteplase (0.9 mg/kg) vs placebo or open control
Design
Pooled individual patient data analysis of 7 RCTs and registry data
Follow-up
Day 90 or day 180
Authors
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Supports alteplase without upper age limit in ischemic stroke; confirms benefit independent of age in Level 1 evidence.
Meta-Analysis
Yes
Does alteplase improve functional outcomes in patients aged >80 years with acute ischemic stroke?
Absolute Event Rate: 19.1% vs 13.1%
p-value: p=0.0109
Alteplase improves functional outcomes without increasing 90-day mortality in patients aged >80 years with acute ischemic stroke, supporting its use without an upper age limit.
Bluhmki et al. (2020) conducted a meta-analysis in Acute ischemic stroke. Alteplase vs. Placebo or open control was evaluated on Good functional outcome (score 0-1, modified Rankin Scale day 90 or Oxford Handicap Score day 180) (p=0.0109). Alteplase administration in acute ischemic stroke patients aged >80 years was associated with a higher proportion of good functional outcomes compared to control (19.1% vs 13.1%; P=0.0109).
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