Older age does not increase risk of hemorrhagic complications after intravenous and/or intra-arterial thrombolysis for acute stroke.
Older age does not increase risk of hemorrhagic complications after intravenous and/or intra-arterial thrombolysis for acute stroke.
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DOI：
10.1016/j.jstrokecerebrovasdis.2008.03.003
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发表时间：
2008-09-01
期刊：
影响因子：
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通讯作者：
Suarez, Jose I
中科院分区：
文献类型：
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作者：
Pundik, Svetlna;McWilliams-Dunnigan, Laurie;Suarez, Jose I
背景：与年轻患者相比，老年人缺血性脑卒中的发病率明显更高，死亡率和发病率也更高。溶栓后颅内出血（ICH）是不良结局的原因之一。然而，目前尚不清楚年龄超过 80 岁是否是静脉内、动脉内或联合溶栓治疗后出血转化的预测因素。 方法：使用 Logistic 回归模型对 488 例连续接受溶栓治疗的缺血性卒中患者的数据库进行分析，以确定年龄超过 80 岁、人口特征、开始治疗时间、神经功能缺损严重程度、给药途径、血糖或平均动脉压等因素是否与溶栓相关。结果：老年组和年轻组的症状性出血发生率分别为12.82%和10.4%。调整给药途径、美国国立卫生研究院卒中量表评分、平均动脉压和血糖后，80岁以上患者溶栓治疗后出现症状性出血的几率与年轻年龄组没有显着差异（比值比[OR] = 1.64；95%置信区间[CI]：0.729-3.66）。高血糖（>150 mg/dL）与症状性脑出血的几率增加相关（OR = 2.32；95% CI：1.09-4.93）。 80 岁以上患者的再通率（OR = 0.8；95% CI：0.4-1.8）和无症状 ICH 发生率（OR = 2.40；95% CI：0.89-6.5）相似。结论：80 岁以上和 80 岁以下患者中，急性缺血性卒中溶栓后发生 ICH 的风险相似。我们的数据表明，提供溶栓治疗的决定不应仅仅基于患者的年龄。
BACKGROUND: The elderly have significantly higher incidence of ischemic stroke and have higher mortality and morbidity compared with younger patients. Intracranial hemorrhage (ICH) after thrombolysis is one of the causes of unfavorable outcome. However, it is unclear whether age over 80 years is a predictor for hemorrhagic transformation after intravenous, intra-arterial, or a combination of both thrombolytic therapies.METHODS: A database of 488 consecutive patients with ischemic stroke who received thrombolytic therapy was analyzed using logistic regression model to determine whether factors such as age over 80 years, demographic characteristics, onset to treatment time, severity of neurologic deficits, route of administration, blood glucose, or mean arterial pressure were associated with symptomatic ICH.RESULTS: The rates of symptomatic hemorrhage were 12.82% and 10.4% in older and younger groups, respectively. The odds of symptomatic hemorrhage after thrombolytic therapy for patients over 80 years of age after adjusting for route of administration, National Institutes of Health Stroke Scale score, mean arterial pressure, and glucose was not significantly different from that of the younger age group (odds ratio [OR] = 1.64; 95% confidence interval [CI]: 0.729-3.66). Hyperglycemia (>150 mg/dL) was associated with increased odds of symptomatic ICH (OR = 2.32; 95% CI: 1.09-4.93). Patients older than 80 years had similar rates of recanalization (OR = 0.8; 95% CI: 0.4-1.8) and rates of asymptomatic ICH (OR = 2.40; 95% CI: 0.89-6.5).CONCLUSIONS: Risks of ICH after thrombolysis for acute ischemic stroke are similar in patients over and under 80 years of age. Our data suggest that the decision to provide thrombolytic therapy should not be solely based on patient's age.