Age should not be a bar to thrombolytic therapy

Thrombolytic treatment for stroke is effective in elderly patients and advice against treating this group should be reviewed, research suggests.

Patients aged above 80 are often thought to have poor prognoses (Photograph: SPL)
Patients aged above 80 are often thought to have poor prognoses (Photograph: SPL)

Despite fears of poor prognosis in patients aged over 80 years, researchers found that treatment improves outcomes, regardless of age.

The findings suggest that age alone should not be a barrier to treatment.

The researchers, led by Nishant Mishra at the University of Glasgow, examined the effectiveness of thrombolysis treatment in stroke patients of all ages.

Thrombolysis is thought to be associated with poorer prognosis in older people, with greater risk for haemorrhage and hospital mortality.

As a result, the European Medicines Agency has not approved thrombolysis with alteplase for patients above 80 years old.

To test whether age affects the effectiveness and safety of the treatment, researchers analysed data from 29,228 stroke patients.

These patients had received either thrombolysis with IV alteplase or no treatment.

In total, 3,439 of the patients were aged over 80. Disability was measured using the modified Rankin scale at baseline and at 90 days after treatment.

Patients of all ages who underwent thrombolysis experienced improved outcomes.

The odds of improved outcomes attenuated slightly in patients aged above 80 years but thrombolytic therapy remained more effective than no treatment in this group.

The authors said that the weight of evidence to date indicated a potential for benefit in older people.

'We conclude that clinical treatment guidelines should be revised to remove the age restriction in use of IV alteplase for acute ischaemic stroke,' they said.

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