Key result
Young stroke patients receiving IV alteplase have ~47% lower odds of SICH than older patients.
Why the study?
The safety and efficacy of IV thrombolysis in young ischemic stroke patients aged 18 to 50 years compared to older patients aged 51 to 80 years needed assessment.
Does intravenous alteplase within 4.5 hours of symptom onset result in lower symptomatic intracerebral hemorrhage and mortality and better functional independence in young stroke patients (18-50 years) compared to older patients (51-80 years)?
Cohort (n=27,671)
Yes
Does intravenous alteplase within 4.5 hours of symptom onset result in lower symptomatic intracerebral hemorrhage and mortality and better functional independence in young stroke patients (18-50 years) compared to older patients (51-80 years)?
Intravenous alteplase is safe and effective in young ischemic stroke patients (18-50 years), who experience significantly lower rates of symptomatic intracerebral hemorrhage and 3-month mortality and higher rates of functional independence compared to patients aged 51-80 years.
Answers are grounded in this paper and cite their sources.
Lower SICH, mortality, and higher independence in young alteplase recipients; supports safety but leaves open prospective confirmation before practice change.
OBJECTIVE: To assess safety and efficacy of thrombolysis in 18- to 50-year-old patients compared to those aged 51 to 80 years recorded in the Safe Implementation of Thrombolysis in Stroke-International Stroke Thrombolysis Register (SITS-ISTR). METHODS: A total of 27,671 patients aged 18-80 years treated with IV alteplase within 4.5 hours of symptom onset were enrolled in SITS-ISTR between 2002 and 2010. Main outcome measures were symptomatic intracerebral hemorrhage (SICH; deterioration of ≥4 points on the NIH Stroke Scale [NIHSS] within 24 hours and type 2 parenchymal hematoma), mortality, and functional independence (modified Rankin Scale [mRS] 0-2) at 3 months. RESULTS: In the 3,246 (11.7%) patients aged 18-50, SICH occurred in 0.6% vs 1.9% in those aged 51-80 (adjusted odds ratio [aOR] 0.53; 95% confidence interval [CI] 0.31-0.90, p = 0.02). Three-month mortality was 4.9% and 14.4%, respectively (aOR 0.49; 95% CI 0.40-0.60, p < 0.001) and functional independence was 72.1% vs 54.5%, respectively (aOR 1.61; 95% CI 1.43-1.80, p < 0.0001). In multivariable analysis in young patients, baseline systolic blood pressure (SBP) was the only independent factor associated with SICH (p = 0.04). Baseline NIHSS, baseline glucose, and signs of infarction in baseline imaging scan were associated with higher mortality and poorer functional outcome. Male gender, mRS before stroke, and atrial fibrillation (AF) were associated with higher mortality, and age, SBP, and previous stroke were associated with mRS. CONCLUSIONS: Treatment with IV alteplase is safe in young ischemic stroke patients and they benefit more compared to older patients. We found several factors associated with SICH, mortality, and functional outcome. These can be used to help in the selection of young ischemic stroke patients for thrombolysis. CLASSIFICATION OF EVIDENCE: This study provides Class III evidence that younger patients (18-50 years) with ischemic stroke symptoms treated with IV alteplase have lower morbidity and mortality compared to older patients (51-80 years).
No takes yet. Share an insight, caveat, or question.
Toni et al. (2012) conducted a cohort in Ischemic stroke (n=27,671). Younger age (18-50 years) among patients treated with IV alteplase vs. Older age (51-80 years) among patients treated with IV alteplase was evaluated on Symptomatic intracerebral hemorrhage (deterioration of >=4 points on the NIHSS within 24 hours and type 2 parenchymal hematoma) (OR 0.53, 95% CI 0.31-0.90, p=0.02). IV alteplase in young stroke patients (18-50y) vs older patients (51-80y) had lower SICH (0.6% vs 1.9%; aOR 0.53, p=0.02), lower 3-month mortality (4.9% vs 14.4%), and higher independence (72.1%).
Synapse has enriched 10 related papers. Consider them for comparative context: