Intravenous Thrombolysis in Patients With Ischemic Stroke Aged ≥90 Years: A Cohort Study From the TRISP Collaboration

Valerian L Altersberger; Norman Rusche; Nicolas Martinez-Majander; Christian Hametner; Jan F Scheitz; Hilde Henon; Maria Luisa Dell'Acqua; Davide Strambo; Jeffrey Stolp; Mirjam R Heldner; Ilaria Grisendi; Dejana R Jovanovic; Yannick Bejot; Alessandro Pezzini; Ronen R Leker; Georg Kägi; Susanne Wegener; Carlo W Cereda; Erik Lindgren; George Ntaios; Ines Piot; Alexandros A Polymeris; Philippe A Lyrer; Silja Räty; Gerli Sibolt; Marjaana Tiainen; Miriam Heyse; Hebun Erdur; Olfa Kaaouana; Visnja Padjen; Marialuisa Zedde; Marcel Arnold; Paul J Nederkoorn; Patrik Michel; Guido Bigliardi; Andrea Zini; Charlotte Cordonnier; Christian H Nolte; Peter A Ringleb; Sami Curtze; Stefan T Engelter; Henrik Gensicke; Thrombolysis in Stroke Patients (TRISP) Collaborators

doi:10.1161/STROKEAHA.122.039426

Intravenous Thrombolysis in Patients With Ischemic Stroke Aged ≥90 Years: A Cohort Study From the TRISP Collaboration

Stroke. 2022 Dec;53(12):3557-3563. doi: 10.1161/STROKEAHA.122.039426. Epub 2022 Oct 14.

Authors

Valerian L Altersberger^#¹, Norman Rusche^#^{1

2}, Nicolas Martinez-Majander³, Christian Hametner⁴, Jan F Scheitz⁵, Hilde Henon⁶, Maria Luisa Dell'Acqua⁷, Davide Strambo⁸, Jeffrey Stolp⁹, Mirjam R Heldner¹⁰, Ilaria Grisendi¹¹, Dejana R Jovanovic¹², Yannick Bejot¹³, Alessandro Pezzini¹⁴, Ronen R Leker¹⁵, Georg Kägi^{10

16}, Susanne Wegener¹⁷, Carlo W Cereda¹⁸, Erik Lindgren¹⁹, George Ntaios²⁰, Ines Piot¹, Alexandros A Polymeris¹, Philippe A Lyrer¹, Silja Räty³, Gerli Sibolt³, Marjaana Tiainen³, Miriam Heyse⁴, Hebun Erdur⁵, Olfa Kaaouana⁶, Visnja Padjen¹², Marialuisa Zedde¹¹, Marcel Arnold¹⁰, Paul J Nederkoorn⁹, Patrik Michel⁸, Guido Bigliardi⁷, Andrea Zini²¹, Charlotte Cordonnier⁶, Christian H Nolte⁵, Peter A Ringleb⁴, Sami Curtze³, Stefan T Engelter^{1

2}, Henrik Gensicke^{1

2}; Thrombolysis in Stroke Patients (TRISP) Collaborators

Affiliations

¹ Stroke Center and Department of Neurology, University Hospital Basel and University of Basel, Switzerland (V.L.A., N.R., I.P., A.A.P., P.A.L., S.T.E., H.G.).
² Neurology and Neurorehabilitation, University Department of Geriatric Medicine FELIX PLATTER, University of Basel, Switzerland (N.R., S.T.E., H.G.).
³ Neurology, University of Helsinki and Helsinki University Hospital, Finland (N.M.-M., S.R., G.S., M.T., S.C.).
⁴ Department of Neurology, University Hospital Heidelberg, Germany C.H., M.H., P.A.R.).
⁵ Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Klinik und Hochschulambulanz für Neurologie, Center for Stroke Research Berlin (CSB), Charité - Universitätsmedizin Berlin, Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Germany (J.F.S., H.E., C.H.N.).
⁶ Univ. Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, F-59000 Lille, France (H.H., O.K., C.C.).
⁷ Neurology - Stroke Unit, Department of Neuroscience, Ospedale Civile di Baggiovara, Modena University Hospital, Italy (M.L.D.A., G.B.).
⁸ Stroke Center, Neurology Service, Lausanne University Hospital and University of Lausanne, Switzerland (D.S., P.M.).
⁹ Amsterdam UMC location University of Amsterdam, Department of Neurology, the Netherlands (J.S., P.J.N.).
¹⁰ Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Switzerland (M.R.H., G.K., M.A.).
¹¹ Neurology Unit-Stroke Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Italy (I.G., M.Z.).
¹² University of Belgrade, Faculty of Medicine, Neurology Clinic, University Clinical Centre of Serbia (D.R.J., V.P.).
¹³ Department of Neurology, University Hospital Dijon, France (Y.B.).
¹⁴ Department of Clinical and Experimental Sciences, Neurology Clinic, University of Brescia, Italy (A.P.).
¹⁵ Department of Neurology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel (R.R.L.).
¹⁶ Department of Neurology, Kantonsspital St. Gallen, Switzerland (G.K.).
¹⁷ Department of Neurology, University Hospital Zurich and University of Zurich, Switzerland (S.W.).
¹⁸ Stroke Center EOC, Neurology, Neurocenter of Southern Switzerland, EOC, Lugano, Switzerland (C.W.C.).
¹⁹ Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg; Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden (E.L.).
²⁰ Department of Internal Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece (G.N.).
²¹ IRCCS Istituto delle Scienze Neurologiche di Bologna, Department of Neurology and Stroke Center, Maggiore Hospital, Bologna, Italy (A.Z.).

^# Contributed equally.

PMID: 36252105
DOI: 10.1161/STROKEAHA.122.039426

Abstract

Background: The probability to receive intravenous thrombolysis (IVT) for treatment of acute ischemic stroke declines with increasing age and is consequently the lowest in very elderly patients. Safety concerns likely influence individual IVT treatment decisions. Using data from a large IVT registry, we aimed to provide more evidence on safety of IVT in the very elderly.

Methods: In this prospective multicenter study from the TRISP (Thrombolysis in Ischemic Stroke Patients) registry, we compared patients ≥90 years with those <90 years using symptomatic intracranial hemorrhage (ECASS [European Cooperative Acute Stroke Study]-II criteria), death, and poor functional outcome in survivors (modified Rankin Scale score 3-5 for patients with prestroke modified Rankin Scale score ≤2 and modified Rankin Scale score 4-5 for patients prestroke modified Rankin Scale ≥3) at 3 months as outcomes. We calculated adjusted odds ratio with 95% CI using logistic regression models.

Results: Of 16 974 eligible patients, 976 (5.7%) were ≥90 years. Patients ≥90 years had higher median National Institutes of Health Stroke Scale on admission (12 versus 8) and were more often dependent prior to the index stroke (prestroke modified Rankin Scale score of ≥3; 45.2% versus 7.4%). Occurrence of symptomatic intracranial hemorrhage (5.7% versus 4.4%, odds ratio_adjusted 1.14 [0.83-1.57]) did not differ significantly between both groups. However, the probability of death (odds ratio_adjusted 3.77 [3.14-4.53]) and poor functional outcome (odds ratio_adjusted 2.63 [2.13-3.25]) was higher in patients aged ≥90 years. Results for the sample of centenarians (n=21) were similar.

Conclusions: The probability of symptomatic intracranial hemorrhage after IVT in very elderly patients with stroke did not exceed that of their younger counterparts. The higher probability of death and poor functional outcome during follow-up in the very elderly seems not to be related to IVT treatment. Very high age itself should not be a reason to withhold IVT.

Keywords: aged; intracranial hemorrhage; ischemic stroke; registries; survivors.

Publication types

Multicenter Study

MeSH terms

Aged
Aged, 80 and over
Brain Ischemia* / drug therapy
Cohort Studies
Fibrinolytic Agents / adverse effects
Humans
Intracranial Hemorrhages / chemically induced
Intracranial Hemorrhages / drug therapy
Intracranial Hemorrhages / epidemiology
Ischemic Stroke*
Prospective Studies
Stroke* / drug therapy
Thrombolytic Therapy / methods
Treatment Outcome

Substances

Fibrinolytic Agents