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Evidence summaries

Intravenous Thrombolysis in Stroke Patients over 80 Years Versus Under 80 Years of Age

Treatment with i.v. recombinant tissue plasminogen activator (rtPA) may have less favourable outcomes in stroke patients 80 years or older than in younger patients. Level of evidence: "C"

A systematic review 1 including 6 studies with a total of 2 244 subjects was abstracted in DARE. The thrombolysed patients had an ischaemic stroke with various etiologies. Patients in the older group (≥80 years) had a higher mortality risk compared with the younger group (<80 years) (OR 3.09, 95% CI 2.37 to 4.03). In 4 studies the recovery, assessed by modified Rankin scale of ≤1 after 3 months, was less favourable for the older group overall (OR 0.53, 95% CI 0.42 to 0.66) and for survivors among the older group (OR 0.69, 95% CI 0.53 to 0.90). There was no difference in symptomatic intracranial haemorrhage between the two groups.

Comment: The quality of evidence is downgraded by limitations in review quality (limited literature search) and by indirectness (differences in the baseline characteristics of the patients) and upgraded by large magnitude of effect.

    References

    • Engelter ST, Bonati LH, Lyrer P A. Intravenous thrombolysis in stroke patients of ≥80 versus <80 years of age: a systematic review across cohort studies. Age Ageing 2006 Nov;35(6):572-80 [PubMed][DARE]

Primary/Secondary Keywords