Intravenous thrombolysis in patients aged more than 80 years in the three rural hospitals in southeast Poland: An observational study

AIMS: Approximately 30% of acute ischemic stroke (AIS) occurs in people aged over 80 years. Older patients are increasingly receiving intravenous thrombolysis (IV-thrombolysis) for AIS; however, the majority of treatments are carried out in urban hospitals. The aim of the present study was to assess the safety and effectiveness of IV-thrombolysis in patients aged older than 80 years. METHODS: We retrospectively evaluated the clinical and epidemiological data of 409 patients with AIS who were consecutively treated with IV-thrombolysis from September 2006 to June 2012 in the three rural hospitals. RESULTS: In the analyzed group, there were 22.3% of patients who were aged over 80 years (2.4% patients aged ≥ 90 years). Among these patients we found: longer onset to door time (P = 0.04), onset to treatment time (P = 0.0003) and door to treatment time (P < 0.0001). The functional independence (modified Rankin Scale 0-2) at 90 days was lower (P = 0.0004), whereas the risk of hemorrhagic transformation (HT; P = 0.001), symptomatic intracerebral hemorrhage (SICH) according to National Institute of Neurological Disorders and Stroke (NINDS) definition (P = 0.003) and mortality rate within 3 months were higher (P < 0.0001) than in younger patients. A multivariate analysis showed no impact of older age on long-term outcome, and the presence of HT and SICH. Age over 80 years was associated with higher mortality rate. CONCLUSIONS: Older age affected the increased times for pre- and in-hospital procedures in rural patients with AIS. Older patients should not be denied the chance to benefit from IV-thrombolysis, but because of the higher mortality, the application of this therapy should be carefully decided on.