Thrombolysis for acute ischaemic stroke (AIS) patients aged ≥80 years is evidence based, although its use in previously dependent patients is controversial.
Methods
Data from 831 thrombolysed AIS patients in our centre from 2009–2017 were used to compare demographic trends and outcomes (haemorrhage, mortality, three-month independence) in patients aged <80 and ≥80 years and with prior dependency. Comparison with UK and world registry data regarding age and pre-stroke dependency was made.
Results
The percentage of treated patients aged ≥80 years increased year-on-year, doubling from 25% to 50% (p<0.01), with increasing average age and pre-stroke dependency in world centres. Patients ≥80 years had higher (p<0.001) stroke severity, symptomatic intracerebral haemorrhage (5% vs. 1.5%), mortality (35% vs. 13%) and lower three month independent survival (24% vs. 60%). Patients with pre-stroke dependency had especially higher three month mortality (57–71%, OR 3.75 [95% CI 1.97–7.15]) in both age groups.
Conclusion
Patients aged ≥80 years and with dependency increasingly receive thrombolysis. Given poorer outcomes thrombolysis trials are needed in pre-stroke dependent patients.
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