Age no bar to clot-busters for stroke
Although elderly stroke patients have a greater risk of dying following treatment with the commonly used clot-buster called tPA (tissue plasminogen activator), age is not an independent predictor of outcome, Swiss researchers report in Neurology.
Commenting on the findings, Dr. J. Claude Hemphill III, co-author of an editorial in the medical journal, told Reuters Health, tPA “should not be withheld from acute stroke patients just because they are very old.”
Hemphill, of the University of California, San Francisco, added that while older patients might have a higher risk of bleeding from tPA, “we know that older patients also are more likely to die and less likely to recover from the stroke itself.”
The study, by Dr. S. T. Engelter of University Hospital Basel and colleagues, involved 325 tPA-treated stroke patients. Of these, 38 were 80 years of age or older, whereas the remaining 287 ranged in age from 14 to 79 years and their average age was 63 years.
The team found that the rate of bleeding in the brain did not differ between the two groups and overall there was a favorable outcome in 29 percent of the older patients and 37 percent of the younger patients. At 3 months, 32 percent of the elderly patients had died compared with 12 percent of the younger patients.
Among patients who survived for 3 months, the rate of favorable outcome was similar in the older and younger set—42 percent and 43 percent, respectively.
According to Engelter and colleagues, stroke severity, time to clot-buster administration, blood sugar level, and history of heart disease—but not age—independently predicted outcome. This study, they conclude, shows that very elderly stroke patients can benefit from tPA administration.
SOURCE: Neurology December 13, 2005.
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