IV tPA Doubles Mortality Rate in Patients with Acute Ischemic Stroke Over Age 80
VANCOUVER, BC—Patients 80 years of age or older who received intravenous tissue plasminogen activator (IV tPA) for acute ischemic stroke had double the mortality rate compared with those who were untreated, a study presented at the 68th AAN Annual Meeting concluded.
Overall, IV tPA did improve clinical outcomes for adults older than 65 years of age, investigators found.
"More nuanced investigation must be done to confirm findings," stated Sarah Song, MD, MPH, of the Section of Cerebrovascular Disease, Department of Neurology, Rush University Medical Center, Chicago, IL, and colleagues. These results have important treatment implications: by 2050, more than 55 million people will be 90 years of age and older in the United States, with those aged 85 years and older the fastest growing segment.
"Current recommendation limit the IV tPA time window for patients with acute ischemic stroke who are over 80 to 3 hours, as opposed to 4.5 hours," they noted.
Using data from the Nationwide Inpatient Sample from 2005 to 2010, the researchers analyzed 344,806 patients with acute ischemic stroke for IV tPA usage, comorbidities, demographics, and clinical outcomes. Of these patients, 12,241 (3.6%) received IV tPA; all were significantly more likely to be younger and white and have more comorbidities, except for diabetes, and less likely to be female (all P<0.0001).
The researchers found that patients treated with IV tPA had double the mortality rate when compared to the non-IV tPA treated group, 12.2% vs. 6.0%; P<0.0001). Median length of stay was also greater for the IV tPA-treated patients (5 vs. 4 days; P<0.0001), and they experienced an increase in bleeding (6.7% vs. 0.6%, P<0.0001). In addition, those who did not receive IV tPA were more likely to be discharged home, 27.4% vs. 20.0% (P<0.0001).
Clinical outcomes were consistent when participants were divided into the age-related subgroups of 65-79 years and 80-plus years. IV tPA usage was associated with higher mortality (10.3% vs. 4.2, P<0.0001 and 14.5% vs. 7.8%, P<0.0001, respectively), increased length of stay (5 vs. 4 days, P<0.0001 and 5 vs. 4 days, P<0.0001, respectively), increased bleeding (6.6% vs. 0.7%, P<0.0001 and 6.8% vs. 0.6%, P<0.0001, respectively), and less frequent discharge home (26.6% vs. 36.8%, P<0.0001 and 11.6% vs. 18.1%, P<0.0001, respectively).