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Tissue Plasminogen Activator Not As Effective in Elderly Patients: Presented at AAN

By Charlene Laino

HONOLULU, HI -- April 7, 2003 -- Elderly patients with acute stroke who are given intravenous tissue plasminogen activator do not fare as well as their younger counterparts, a new study shows.

Mikael S. Mouradian, a neurologist at the University of Alberta in Edmonton, Canada, presented the findings here on April 3^rd at the 55^th Annual Meeting of American Academy of Neurology.

Dr. Mouradian said the study was undertaken to try to find out more about whether tissue plasminogen activator, the standard of care for adult acute stroke patients, is effective in patients over age 80.

The study enrolled 97 patients who received intravenous tissue plasminogen activator at the university hospital from January 1999 to December 2001. The patients were divided into two groups according to age: those 79 and younger, and those 80 and older. Thirty two of the patients were 80 or older, with the oldest patient being 96. The 65 younger patients ranged in age from 32 to 79.

Forty-one of the 65 younger patients (63%) were admitted with a National Institute of Health Stroke Scale (NIHSS) score of 11 or higher. In the older age group, 27 of 32 patients (84%) presented with an NIHSS score of 11 or higher, a significant difference (p=0.03).

Three months later, 11% (7/65) of the younger patients had died, compared with 34% (11 out of 32) of those in the older group (p=0.005). By three years, the mortality rate was 15% (10/65) in the younger age group versus 50% (16/32) in the older group (p=0.001).

There was also a significant difference in symptomatic intracranial hemorrhage rates, with 6.15% of the younger patients and 9.37% of the older patients afflicted (p=0.6). Also, only 16% of the older patients were able to return to independent living, compared with 58.5% of those in the younger group.

Mutivariate analysis showed that both older age and higher admission NIHSS scores are independent predictors for death or dependent living, Dr. Mouradian said.

More studies are needed to identify predictors for outcome, he said, as such information could be used to improve patient selection for t-PA treatment, especially in the older population.


[Study title: Elderly Patients May Not Respond Well to Treatment with Intravenous rt-PA. A Prospective Study of 97 Consecutive Patients. Abstract: S53.006]

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