Thrombolytic therapy with intravenous recombinant tissue plasminogen activator in Japanese older patients with acute ischemic stroke: Fukuoka Stroke Registry

for the FSR investigators

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Abstract

Aim: The present study aimed to determine the efficacy and safety of thrombolytic therapy with recombinant tissue plasminogen activator (rt-PA) therapy in older patients compared with younger patients. Methods: Using the Fukuoka Stroke Registry, a prospective multicenter study for acute stroke in Japan, we analyzed data of 401 patients with acute ischemic stroke (aged 74.5±13.1 years) treated with thrombolytic therapy using rt-PA. Patients were categorized into two groups according to age: those aged ≥75 years (n=240) and <75 years (n=161). Neurological improvement was defined as a decrease in the National Institute of Health Stroke Scale (NIHSS) score of ≥4 during hospitalization or an NIHSS score of 0 at discharge. Good functional outcome was defined as a modified Rankin scale score of 0-2 at 3 months after onset. Results: Neurological symptoms at admission were more severe in older patients than in younger patients. Old age (≥75 years) was not associated with neurological deterioration (multivariate-adjusted odds ratio [OR] 0.90, 95% confidence interval [CI] 0.46-1.77), neurological improvement (multivariate-adjusted OR 0.91, 95% CI 0.54-1.53) and symptomatic intracranial hemorrhage (multivariate-adjusted OR 1.11, 95% CI 0.19-8.87). Old age was negatively associated with good functional outcome (multivariate-adjusted OR 0.29, 95% CI 0.16-0.52) and positively associated with in-hospital mortality (multivariate-adjusted OR 19.3, 95% CI 2.4-474.9). Conclusions: In patients treated with rt-PA, old age is associated with poor functional outcome and in-hospital mortality. However, the probability of neurological improvement and symptomatic intracranial hemorrhage in older patients is comparable with that in younger patients.

Original languageEnglish
Pages (from-to)954-959
Number of pages6
JournalGeriatrics and Gerontology International
Volume14
Issue number4
DOIs
Publication statusPublished - Oct 1 2014

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Thrombolytic Therapy
Tissue Plasminogen Activator
stroke
Registries
confidence
Stroke
old age
Odds Ratio
Confidence Intervals
mortality
Intracranial Hemorrhages
National Institutes of Health (U.S.)
Hospital Mortality
health
hospitalization
Japan
Multicenter Studies
Hospitalization
Prospective Studies
Group

All Science Journal Classification (ASJC) codes

  • Health(social science)
  • Gerontology
  • Geriatrics and Gerontology

Cite this

@article{ce32517fbf9e42af91addfc764dcfcf0,
title = "Thrombolytic therapy with intravenous recombinant tissue plasminogen activator in Japanese older patients with acute ischemic stroke: Fukuoka Stroke Registry",
abstract = "Aim: The present study aimed to determine the efficacy and safety of thrombolytic therapy with recombinant tissue plasminogen activator (rt-PA) therapy in older patients compared with younger patients. Methods: Using the Fukuoka Stroke Registry, a prospective multicenter study for acute stroke in Japan, we analyzed data of 401 patients with acute ischemic stroke (aged 74.5±13.1 years) treated with thrombolytic therapy using rt-PA. Patients were categorized into two groups according to age: those aged ≥75 years (n=240) and <75 years (n=161). Neurological improvement was defined as a decrease in the National Institute of Health Stroke Scale (NIHSS) score of ≥4 during hospitalization or an NIHSS score of 0 at discharge. Good functional outcome was defined as a modified Rankin scale score of 0-2 at 3 months after onset. Results: Neurological symptoms at admission were more severe in older patients than in younger patients. Old age (≥75 years) was not associated with neurological deterioration (multivariate-adjusted odds ratio [OR] 0.90, 95{\%} confidence interval [CI] 0.46-1.77), neurological improvement (multivariate-adjusted OR 0.91, 95{\%} CI 0.54-1.53) and symptomatic intracranial hemorrhage (multivariate-adjusted OR 1.11, 95{\%} CI 0.19-8.87). Old age was negatively associated with good functional outcome (multivariate-adjusted OR 0.29, 95{\%} CI 0.16-0.52) and positively associated with in-hospital mortality (multivariate-adjusted OR 19.3, 95{\%} CI 2.4-474.9). Conclusions: In patients treated with rt-PA, old age is associated with poor functional outcome and in-hospital mortality. However, the probability of neurological improvement and symptomatic intracranial hemorrhage in older patients is comparable with that in younger patients.",
author = "{for the FSR investigators} and Ryu Matsuo and Masahiro Kamouchi and Tetsuro Ago and Jun Hata and Yuji Shono and Junya Kuroda and Yoshinobu Wakisaka and Hiroshi Sugimori and Takanari Kitazono and Takao Ishitsuka and Shigeru Fujimoto and Setsuro Ibayashi and Kenji Kusuda and Shuji Arakawa and Katsumi Irie and Kenichiro Fujii and Yasushi Okada and Masahiro Yasaka and Tetsuhiko Nagao and Hiroaki Ooboshi and Tsuyoshi Omae and Kazunori Toyoda and Hiroshi Nakane and Yoshihisa Fukushima and Seizo Sadoshima and Kinya Tamaki",
year = "2014",
month = "10",
day = "1",
doi = "10.1111/ggi.12205",
language = "English",
volume = "14",
pages = "954--959",
journal = "Geriatrics and Gerontology International",
issn = "1447-0594",
publisher = "Japan Geriatrics Society",
number = "4",

}

TY - JOUR

T1 - Thrombolytic therapy with intravenous recombinant tissue plasminogen activator in Japanese older patients with acute ischemic stroke

T2 - Fukuoka Stroke Registry

AU - for the FSR investigators

AU - Matsuo, Ryu

AU - Kamouchi, Masahiro

AU - Ago, Tetsuro

AU - Hata, Jun

AU - Shono, Yuji

AU - Kuroda, Junya

AU - Wakisaka, Yoshinobu

AU - Sugimori, Hiroshi

AU - Kitazono, Takanari

AU - Ishitsuka, Takao

AU - Fujimoto, Shigeru

AU - Ibayashi, Setsuro

AU - Kusuda, Kenji

AU - Arakawa, Shuji

AU - Irie, Katsumi

AU - Fujii, Kenichiro

AU - Okada, Yasushi

AU - Yasaka, Masahiro

AU - Nagao, Tetsuhiko

AU - Ooboshi, Hiroaki

AU - Omae, Tsuyoshi

AU - Toyoda, Kazunori

AU - Nakane, Hiroshi

AU - Fukushima, Yoshihisa

AU - Sadoshima, Seizo

AU - Tamaki, Kinya

PY - 2014/10/1

Y1 - 2014/10/1

N2 - Aim: The present study aimed to determine the efficacy and safety of thrombolytic therapy with recombinant tissue plasminogen activator (rt-PA) therapy in older patients compared with younger patients. Methods: Using the Fukuoka Stroke Registry, a prospective multicenter study for acute stroke in Japan, we analyzed data of 401 patients with acute ischemic stroke (aged 74.5±13.1 years) treated with thrombolytic therapy using rt-PA. Patients were categorized into two groups according to age: those aged ≥75 years (n=240) and <75 years (n=161). Neurological improvement was defined as a decrease in the National Institute of Health Stroke Scale (NIHSS) score of ≥4 during hospitalization or an NIHSS score of 0 at discharge. Good functional outcome was defined as a modified Rankin scale score of 0-2 at 3 months after onset. Results: Neurological symptoms at admission were more severe in older patients than in younger patients. Old age (≥75 years) was not associated with neurological deterioration (multivariate-adjusted odds ratio [OR] 0.90, 95% confidence interval [CI] 0.46-1.77), neurological improvement (multivariate-adjusted OR 0.91, 95% CI 0.54-1.53) and symptomatic intracranial hemorrhage (multivariate-adjusted OR 1.11, 95% CI 0.19-8.87). Old age was negatively associated with good functional outcome (multivariate-adjusted OR 0.29, 95% CI 0.16-0.52) and positively associated with in-hospital mortality (multivariate-adjusted OR 19.3, 95% CI 2.4-474.9). Conclusions: In patients treated with rt-PA, old age is associated with poor functional outcome and in-hospital mortality. However, the probability of neurological improvement and symptomatic intracranial hemorrhage in older patients is comparable with that in younger patients.

AB - Aim: The present study aimed to determine the efficacy and safety of thrombolytic therapy with recombinant tissue plasminogen activator (rt-PA) therapy in older patients compared with younger patients. Methods: Using the Fukuoka Stroke Registry, a prospective multicenter study for acute stroke in Japan, we analyzed data of 401 patients with acute ischemic stroke (aged 74.5±13.1 years) treated with thrombolytic therapy using rt-PA. Patients were categorized into two groups according to age: those aged ≥75 years (n=240) and <75 years (n=161). Neurological improvement was defined as a decrease in the National Institute of Health Stroke Scale (NIHSS) score of ≥4 during hospitalization or an NIHSS score of 0 at discharge. Good functional outcome was defined as a modified Rankin scale score of 0-2 at 3 months after onset. Results: Neurological symptoms at admission were more severe in older patients than in younger patients. Old age (≥75 years) was not associated with neurological deterioration (multivariate-adjusted odds ratio [OR] 0.90, 95% confidence interval [CI] 0.46-1.77), neurological improvement (multivariate-adjusted OR 0.91, 95% CI 0.54-1.53) and symptomatic intracranial hemorrhage (multivariate-adjusted OR 1.11, 95% CI 0.19-8.87). Old age was negatively associated with good functional outcome (multivariate-adjusted OR 0.29, 95% CI 0.16-0.52) and positively associated with in-hospital mortality (multivariate-adjusted OR 19.3, 95% CI 2.4-474.9). Conclusions: In patients treated with rt-PA, old age is associated with poor functional outcome and in-hospital mortality. However, the probability of neurological improvement and symptomatic intracranial hemorrhage in older patients is comparable with that in younger patients.

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U2 - 10.1111/ggi.12205

DO - 10.1111/ggi.12205

M3 - Article

C2 - 24320947

AN - SCOPUS:84931832263

VL - 14

SP - 954

EP - 959

JO - Geriatrics and Gerontology International

JF - Geriatrics and Gerontology International

SN - 1447-0594

IS - 4

ER -