Intravenous thrombolysis for acute ischemic stroke in centenarians
Key summary points Aim Evaluate clinical and functional outcomes of centenarians treated with intravenous thrombolysis for acute ischemic stroke. Findings Three out of four patients were functionally independent 90 days after discharge. No serious hemorrhagic or systemic adverse events secondary to...
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| Vydáno v: | European geriatric medicine Ročník 12; číslo 4; s. 893 - 897 |
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| Hlavní autoři: | , , , , , , , , , , |
| Médium: | Journal Article |
| Jazyk: | angličtina |
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Cham
Springer International Publishing
01.08.2021
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| ISSN: | 1878-7657, 1878-7649, 1878-7657 |
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| Abstract | Key summary points
Aim
Evaluate clinical and functional outcomes of centenarians treated with intravenous thrombolysis for acute ischemic stroke.
Findings
Three out of four patients were functionally independent 90 days after discharge. No serious hemorrhagic or systemic adverse events secondary to treatment were registered..
Message
Intravenous thrombolysis may be beneficial in patients over 100 years.
Purpose
The benefit of intravenous alteplase is well established for patients with disabling stroke symptoms regardless of age, although data on outcomes in centenarian patients are scarce. We present our experience in patients beyond 100 years.
Methods
Descriptive study including centenarians from our single-centre prospective registry who underwent intravenous thrombolysis with alteplase for acute ischemic stroke in our tertiary university hospital. Clinical variables and functional outcome at 3 months were collected.
Results
Four patients, all women, functionally independent (mRS ≤ 2) were included. Treatment with alteplase was applied within 4.5 h of stroke onset. One patient complicated with pneumonia and died. Two patients were functionally independent (mRS ≤ 2) at discharge, while the third was partially dependent (mRS of 3 at discharge), improving after 3 months, (mRS 2). No serious hemorrhagic or systemic adverse events were registered.
Conclusion
In our experience, intravenous thrombolysis may be beneficial and should be considered in patients over 100 years old with no previous disability. |
|---|---|
| AbstractList | The benefit of intravenous alteplase is well established for patients with disabling stroke symptoms regardless of age, although data on outcomes in centenarian patients are scarce. We present our experience in patients beyond 100 years.
Descriptive study including centenarians from our single-centre prospective registry who underwent intravenous thrombolysis with alteplase for acute ischemic stroke in our tertiary university hospital. Clinical variables and functional outcome at 3 months were collected.
Four patients, all women, functionally independent (mRS ≤ 2) were included. Treatment with alteplase was applied within 4.5 h of stroke onset. One patient complicated with pneumonia and died. Two patients were functionally independent (mRS ≤ 2) at discharge, while the third was partially dependent (mRS of 3 at discharge), improving after 3 months, (mRS 2). No serious hemorrhagic or systemic adverse events were registered.
In our experience, intravenous thrombolysis may be beneficial and should be considered in patients over 100 years old with no previous disability. Key summary points Aim Evaluate clinical and functional outcomes of centenarians treated with intravenous thrombolysis for acute ischemic stroke. Findings Three out of four patients were functionally independent 90 days after discharge. No serious hemorrhagic or systemic adverse events secondary to treatment were registered.. Message Intravenous thrombolysis may be beneficial in patients over 100 years. Purpose The benefit of intravenous alteplase is well established for patients with disabling stroke symptoms regardless of age, although data on outcomes in centenarian patients are scarce. We present our experience in patients beyond 100 years. Methods Descriptive study including centenarians from our single-centre prospective registry who underwent intravenous thrombolysis with alteplase for acute ischemic stroke in our tertiary university hospital. Clinical variables and functional outcome at 3 months were collected. Results Four patients, all women, functionally independent (mRS ≤ 2) were included. Treatment with alteplase was applied within 4.5 h of stroke onset. One patient complicated with pneumonia and died. Two patients were functionally independent (mRS ≤ 2) at discharge, while the third was partially dependent (mRS of 3 at discharge), improving after 3 months, (mRS 2). No serious hemorrhagic or systemic adverse events were registered. Conclusion In our experience, intravenous thrombolysis may be beneficial and should be considered in patients over 100 years old with no previous disability. The benefit of intravenous alteplase is well established for patients with disabling stroke symptoms regardless of age, although data on outcomes in centenarian patients are scarce. We present our experience in patients beyond 100 years.PURPOSEThe benefit of intravenous alteplase is well established for patients with disabling stroke symptoms regardless of age, although data on outcomes in centenarian patients are scarce. We present our experience in patients beyond 100 years.Descriptive study including centenarians from our single-centre prospective registry who underwent intravenous thrombolysis with alteplase for acute ischemic stroke in our tertiary university hospital. Clinical variables and functional outcome at 3 months were collected.METHODSDescriptive study including centenarians from our single-centre prospective registry who underwent intravenous thrombolysis with alteplase for acute ischemic stroke in our tertiary university hospital. Clinical variables and functional outcome at 3 months were collected.Four patients, all women, functionally independent (mRS ≤ 2) were included. Treatment with alteplase was applied within 4.5 h of stroke onset. One patient complicated with pneumonia and died. Two patients were functionally independent (mRS ≤ 2) at discharge, while the third was partially dependent (mRS of 3 at discharge), improving after 3 months, (mRS 2). No serious hemorrhagic or systemic adverse events were registered.RESULTSFour patients, all women, functionally independent (mRS ≤ 2) were included. Treatment with alteplase was applied within 4.5 h of stroke onset. One patient complicated with pneumonia and died. Two patients were functionally independent (mRS ≤ 2) at discharge, while the third was partially dependent (mRS of 3 at discharge), improving after 3 months, (mRS 2). No serious hemorrhagic or systemic adverse events were registered.In our experience, intravenous thrombolysis may be beneficial and should be considered in patients over 100 years old with no previous disability.CONCLUSIONIn our experience, intravenous thrombolysis may be beneficial and should be considered in patients over 100 years old with no previous disability. |
| Author | Rodríguez Jorge, F. Matute Lozano, M. C. Masjuan Vallejo, J. Sainz Amo, R. Sánchez Sánchez, A. Cruz Culebras, A. García-Madrona, S. Vera Lechuga, R. De Felipe Mimbrera, A. Baena Álvarez, B. Gómez Corral, J. |
| Author_xml | – sequence: 1 givenname: B. surname: Baena Álvarez fullname: Baena Álvarez, B. email: bbaena93@hotmail.es organization: Department of Neurology, Hospital Universitario Ramón y Cajal – sequence: 2 givenname: S. surname: García-Madrona fullname: García-Madrona, S. organization: Department of Neurology, Hospital Universitario Ramón y Cajal, Department of Medicine, Universidad de Alcalá, IRYCIS – sequence: 3 givenname: R. surname: Sainz Amo fullname: Sainz Amo, R. organization: Department of Neurology, Hospital Universitario Ramón y Cajal – sequence: 4 givenname: F. surname: Rodríguez Jorge fullname: Rodríguez Jorge, F. organization: Department of Neurology, Hospital Universitario Ramón y Cajal – sequence: 5 givenname: J. surname: Gómez Corral fullname: Gómez Corral, J. organization: Department of Neurology, Hospital Universitario Ramón y Cajal – sequence: 6 givenname: R. surname: Vera Lechuga fullname: Vera Lechuga, R. organization: Department of Neurology, Hospital Universitario Ramón y Cajal – sequence: 7 givenname: M. C. surname: Matute Lozano fullname: Matute Lozano, M. C. organization: Department of Neurology, Hospital Universitario Ramón y Cajal – sequence: 8 givenname: A. surname: Sánchez Sánchez fullname: Sánchez Sánchez, A. organization: Department of Neurology, Hospital Universitario Ramón y Cajal – sequence: 9 givenname: A. surname: De Felipe Mimbrera fullname: De Felipe Mimbrera, A. organization: Department of Neurology, Hospital Universitario Ramón y Cajal – sequence: 10 givenname: A. surname: Cruz Culebras fullname: Cruz Culebras, A. organization: Department of Neurology, Hospital Universitario Ramón y Cajal – sequence: 11 givenname: J. surname: Masjuan Vallejo fullname: Masjuan Vallejo, J. organization: Department of Neurology, Hospital Universitario Ramón y Cajal, Department of Medicine, Universidad de Alcalá, IRYCIS |
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| References | Stroke Alliance for Europe (SAFE) (2017) The burden of stroke in Europe: The challenge for policy makers. SAFE. https://www.stroke.org.uk/sites/default/files/the_burden_of_stroke_in_europe_-_challenges_for_policy_makers.pdf. Accessed 1 Dec 2020 LydenPRamanRLiuLNational Institutes of Health Stroke Scale certification is reliable across multiple venuesStroke2009402507325110.1161/STROKEAHA.108.532069195209982726278 BehrouzRMasjuán-VallejoJVeraROutcomes of nonagenarians with acute ischemic stroke treated with intravenous thrombolyticsJ Stroke Cerebrovasc Dis201827124625610.1016/j.jstrokecerebrovasdis.2017.08.03128935502 SandercockPWardlawJMLindleyRIthe IST-3 Collaborative GroupThe benefits and harms of intravenous thrombolysis with recombinant tissue plasminogen activator within 6 h of acute ischaemic stroke (the third international stroke trial [IST-3]): a randomised controlled trialLancet2012379235223631:CAS:528:DC%2BC38XnsVGjtLg%3D10.1016/S0140-6736(12)60768-522632908 WafaHAWolfeCDAEmmettEBurden of stroke in Europe: thirty-year projections of incidence, prevalence, deaths, and disability-adjusted life yearsStroke20205182418242710.1161/STROKEAHA.120.029606326463257382540 BhatnagarPSinhaDParkerRAIntravenous thrombolysis in acute ischaemic stroke: a systematic review and meta-analysis to aid decision making in patients over 80 years of ageJ Neurol Neurosurg Psychiatry201182771271710.1136/jnnp.2010.22314921292789 United Nations, Department of Economic and Social Affairs, Population Division. World population prospects: the 2019 revision. https://population.un.org/wpp/. Accessed 1 Dec 2020 RinglebPABousserMGFordGEuropean Stroke Organisation (ESO) Executive Committee; ESO Writing CommitteeGuidelines for management of ischaemic stroke and transient ischaemic attack 2008Cerebrovasc Dis.20082545750710.1159/000131083 EmbersonJLeesKRLydenPEffect of treatment delay, age, and stroke severity on the effects of intravenous thrombolysis with alteplase for acute ischaemic stroke: a meta-analysis of individual patient data from randomised trialsLancet20143849958192919351:CAS:528:DC%2BC2cXhtlSqurjE10.1016/S0140-6736(14)60584-5251060634441266 WardlawJMMurrayVBergeEThrombolysis for acute ischaemic strokeCochrane Database Syst Rev20094CD00021310.1002/14651858.CD000213.pub2 GormanMJTanneDLewandowskiCACentenarian stroke treated with tissue-type plasminogen activatorCerebrovasc Dis20021342852871:CAS:528:DC%2BD38Xjs1GksL0%3D10.1159/00005785712011555 OlsenTSAndersenKKStroke in centenariansGeriatr Gerontol Int2014141848810.1111/ggi.1205823530536 National Institute of Neurological Disorders and Stroke rt-PA Stroke Study GroupTissue plasminogen activator for acute ischemic strokeN Engl J Med1995333241581158710.1056/NEJM199512143332401 García-CaldenteyJde LeciñanaMASimalPIntravenous thrombolytic treatment in the oldest oldStroke Res Treat2012201292367610.1155/2012/923676228488663405727 Wilkins E, Wilson L, Wickramasinghe K et al. (2017) European Cardiovascular Disease Statistics 2017. Brussels: European Heart Network. http://www.ehnheart.org/cvd-statistics/cvd-statistics-2017.html. Accessed 1 Dec 2020 494_CR2 494_CR1 494_CR4 R Behrouz (494_CR12) 2018; 27 HA Wafa (494_CR3) 2020; 51 P Lyden (494_CR9) 2009; 40 P Bhatnagar (494_CR13) 2011; 82 J García-Caldentey (494_CR8) 2012; 2012 JM Wardlaw (494_CR6) 2009; 4 TS Olsen (494_CR10) 2014; 14 P Sandercock (494_CR7) 2012; 379 J Emberson (494_CR14) 2014; 384 PA Ringleb (494_CR15) 2008; 25 MJ Gorman (494_CR11) 2002; 13 National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group (494_CR5) 1995; 333 |
| References_xml | – reference: SandercockPWardlawJMLindleyRIthe IST-3 Collaborative GroupThe benefits and harms of intravenous thrombolysis with recombinant tissue plasminogen activator within 6 h of acute ischaemic stroke (the third international stroke trial [IST-3]): a randomised controlled trialLancet2012379235223631:CAS:528:DC%2BC38XnsVGjtLg%3D10.1016/S0140-6736(12)60768-522632908 – reference: National Institute of Neurological Disorders and Stroke rt-PA Stroke Study GroupTissue plasminogen activator for acute ischemic strokeN Engl J Med1995333241581158710.1056/NEJM199512143332401 – reference: Stroke Alliance for Europe (SAFE) (2017) The burden of stroke in Europe: The challenge for policy makers. SAFE. https://www.stroke.org.uk/sites/default/files/the_burden_of_stroke_in_europe_-_challenges_for_policy_makers.pdf. Accessed 1 Dec 2020 – reference: BehrouzRMasjuán-VallejoJVeraROutcomes of nonagenarians with acute ischemic stroke treated with intravenous thrombolyticsJ Stroke Cerebrovasc Dis201827124625610.1016/j.jstrokecerebrovasdis.2017.08.03128935502 – reference: RinglebPABousserMGFordGEuropean Stroke Organisation (ESO) Executive Committee; ESO Writing CommitteeGuidelines for management of ischaemic stroke and transient ischaemic attack 2008Cerebrovasc Dis.20082545750710.1159/000131083 – reference: BhatnagarPSinhaDParkerRAIntravenous thrombolysis in acute ischaemic stroke: a systematic review and meta-analysis to aid decision making in patients over 80 years of ageJ Neurol Neurosurg Psychiatry201182771271710.1136/jnnp.2010.22314921292789 – reference: LydenPRamanRLiuLNational Institutes of Health Stroke Scale certification is reliable across multiple venuesStroke2009402507325110.1161/STROKEAHA.108.532069195209982726278 – reference: WardlawJMMurrayVBergeEThrombolysis for acute ischaemic strokeCochrane Database Syst Rev20094CD00021310.1002/14651858.CD000213.pub2 – reference: United Nations, Department of Economic and Social Affairs, Population Division. World population prospects: the 2019 revision. https://population.un.org/wpp/. Accessed 1 Dec 2020 – reference: EmbersonJLeesKRLydenPEffect of treatment delay, age, and stroke severity on the effects of intravenous thrombolysis with alteplase for acute ischaemic stroke: a meta-analysis of individual patient data from randomised trialsLancet20143849958192919351:CAS:528:DC%2BC2cXhtlSqurjE10.1016/S0140-6736(14)60584-5251060634441266 – reference: García-CaldenteyJde LeciñanaMASimalPIntravenous thrombolytic treatment in the oldest oldStroke Res Treat2012201292367610.1155/2012/923676228488663405727 – reference: WafaHAWolfeCDAEmmettEBurden of stroke in Europe: thirty-year projections of incidence, prevalence, deaths, and disability-adjusted life yearsStroke20205182418242710.1161/STROKEAHA.120.029606326463257382540 – reference: Wilkins E, Wilson L, Wickramasinghe K et al. (2017) European Cardiovascular Disease Statistics 2017. Brussels: European Heart Network. http://www.ehnheart.org/cvd-statistics/cvd-statistics-2017.html. Accessed 1 Dec 2020 – reference: OlsenTSAndersenKKStroke in centenariansGeriatr Gerontol Int2014141848810.1111/ggi.1205823530536 – reference: GormanMJTanneDLewandowskiCACentenarian stroke treated with tissue-type plasminogen activatorCerebrovasc Dis20021342852871:CAS:528:DC%2BD38Xjs1GksL0%3D10.1159/00005785712011555 – volume: 25 start-page: 457 year: 2008 ident: 494_CR15 publication-title: Cerebrovasc Dis. doi: 10.1159/000131083 – volume: 379 start-page: 2352 year: 2012 ident: 494_CR7 publication-title: Lancet doi: 10.1016/S0140-6736(12)60768-5 – volume: 40 start-page: 2507 year: 2009 ident: 494_CR9 publication-title: Stroke doi: 10.1161/STROKEAHA.108.532069 – volume: 27 start-page: 246 issue: 1 year: 2018 ident: 494_CR12 publication-title: J Stroke Cerebrovasc Dis doi: 10.1016/j.jstrokecerebrovasdis.2017.08.031 – volume: 14 start-page: 84 issue: 1 year: 2014 ident: 494_CR10 publication-title: Geriatr Gerontol Int doi: 10.1111/ggi.12058 – ident: 494_CR1 – ident: 494_CR4 – ident: 494_CR2 – volume: 2012 start-page: 923676 year: 2012 ident: 494_CR8 publication-title: Stroke Res Treat doi: 10.1155/2012/923676 – volume: 51 start-page: 2418 issue: 8 year: 2020 ident: 494_CR3 publication-title: Stroke doi: 10.1161/STROKEAHA.120.029606 – volume: 13 start-page: 285 issue: 4 year: 2002 ident: 494_CR11 publication-title: Cerebrovasc Dis doi: 10.1159/000057857 – volume: 82 start-page: 712 issue: 7 year: 2011 ident: 494_CR13 publication-title: J Neurol Neurosurg Psychiatry doi: 10.1136/jnnp.2010.223149 – volume: 384 start-page: 1929 issue: 9958 year: 2014 ident: 494_CR14 publication-title: Lancet doi: 10.1016/S0140-6736(14)60584-5 – volume: 4 start-page: CD000213 year: 2009 ident: 494_CR6 publication-title: Cochrane Database Syst Rev doi: 10.1002/14651858.CD000213.pub2 – volume: 333 start-page: 1581 issue: 24 year: 1995 ident: 494_CR5 publication-title: N Engl J Med doi: 10.1056/NEJM199512143332401 |
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Evaluate clinical and functional outcomes of centenarians treated with intravenous thrombolysis for acute ischemic stroke.
Findings... The benefit of intravenous alteplase is well established for patients with disabling stroke symptoms regardless of age, although data on outcomes in... |
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