Is Thrombolysis Safe in the Elderly? Analysis of a National Database
Is Thrombolysis Safe in the Elderly? Analysis of a National Database
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DOI：
10.1161/strokeaha.110.588632
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发表时间：
2010-10-01
期刊：
影响因子：
8.3
通讯作者：
Cruz-Flores, Salvador
中科院分区：
文献类型：
--
作者：
Alshekhlee, Amer;Mohammadi, Afshin;Cruz-Flores, Salvador
背景与目的：老年人急性缺血性脑卒中很少采用溶栓治疗。方法：在本研究中，我们评估了溶栓的风险，包括该人群的死亡率和脑出血（ICH）率。从2000-2006年的国家住院患者样本数据库中确定了一组患者。年龄分为18 ~ 80岁和80 ~ 80岁两组。采用多变量logistic回归分析评估与住院死亡率和脑出血相关的协变量。急性缺血性脑卒中共入院524997例；143093例（27.2%）为80岁。共有7950例患者接受了溶栓治疗，其中1659例（20.9%）为80岁以上患者。老年患者接受溶栓的频率低于年轻患者（1.05%对1.72%）。结果：在整个队列中，老年人群的死亡率较高（12.80%比8.99%）。在接受溶栓治疗的患者中，80 ~ 80岁患者的死亡率和脑出血风险较高（16.9%对11.5%；比值比分别为1.56 [95% CI: 1.35 ~ 1.82]和5.73%对4.40%；比值比分别为1.31 [95% CI: 1.03 ~ 1.67]）。多因素logistic回归分析显示脑出血（优势比：2.24 [95% CI: 1.89 ~ 2.65]）与较高的死亡率相关，但与溶栓治疗无关（优势比：1.14 [95% CI: 0.98 ~ 1.33]）。结论：尽管老年人群死亡率较高，但使用溶栓并不预示死亡；然而，溶栓的使用与脑出血的高风险相关。(中风。2010;41:2259 - 2264)。
Background and Purpose-Thrombolysis for acute ischemic stroke in the elderly population is seldom administered.Methods-In this study, we evaluated the risks of thrombolysis, including the mortality and intracerebral hemorrhage (ICH) rates in this population. A cohort of patients was identified from the National Inpatient Sample database for the years 2000-2006. Age was categorized in 2 groups, including those between 18 and 80 years and those >80 years. Multivariate logistic regression analysis was used to assess covariates associated with hospital mortality and ICH. A total of 524 997 patients were admitted for acute ischemic stroke; 143 093 (27.2%) were >80 years. A total of 7950 patients were treated with thrombolysis, of which 1659 (20.9%) were >80 years. Elderly patients received less frequent thrombolysis compared with the younger population (1.05% versus 1.72%).Results-In the whole cohort, the mortality rate was higher in the older population (12.80% versus 8.99%). For those treated with thrombolysis, the mortality rate and risk of ICH were higher among those >80 years (16.9% versus 11.5%; odds ratio: 1.56 [95% CI: 1.35 to 1.82] and 5.73% versus 4.40%; odds ratio: 1.31 [95% CI: 1.03 to 1.67], respectively). Multivariate logistic regression analysis showed that the presence of ICH (odds ratio: 2.24 [95% CI: 1.89 to 2.65]) was associated with higher mortality rates but not the use of thrombolysis (odds ratio: 1.14 [95% CI: 0.98 to 1.33]).Conclusions-Despite the higher mortality rate in the older population, the use of thrombolysis does not predict death; however, the use of thrombolysis was associated with high risk of ICH. (Stroke. 2010;41:2259-2264.)