Intravenous thrombolysis with recombinant tissue plasminogen activator for ischemic stroke patients over 80 years old: the Fukuoka Stroke Registry.
Intravenous thrombolysis with recombinant tissue plasminogen activator for ischemic stroke patients over 80 years old: the Fukuoka Stroke Registry.
复制标题
DOI：
10.1371/journal.pone.0110444
复制
发表时间：
2014
期刊：
影响因子：
3.7
通讯作者：
FSR Investigators
中科院分区：
文献类型：
--
作者：
Matsuo R;Kamouchi M;Fukuda H;Hata J;Wakisaka Y;Kuroda J;Ago T;Kitazono T;FSR Investigators
静脉注射重组组织型纤溶酶原激活剂(rt-PA)对高龄急性缺血性卒中患者的疗效尚不清楚。本研究的目的是阐明静脉注射rt-PA治疗80岁以上老年患者的有效性和安全性。在1999年6月至2013年2月在日本福冈卒中登记处登记的13,521名卒中患者中，953名80岁以上、发病3小时内住院且未接受血管内治疗的缺血性卒中患者纳入本研究。其中153例给予rt-PA(0.6 mg/kg)静脉滴注。采用1：1与使用rt-PA倾向匹配的病例对照分析方法，选择148例接受rt-PA治疗的患者和148例未接受rt-PA治疗的PS匹配患者进行病例对照分析。临床结果是神经功能改善、出院时良好的功能结果、住院死亡率和出血并发症(任何颅内出血[ICH]、症状性ICH和胃肠道出血)。在953名患者的全队列中，rt-PA的使用与神经功能改善和良好的功能结果呈正相关，而与调整多个混杂因素后的住院死亡率呈负相关。在PS匹配的病例对照分析中，接受rt-PA治疗的患者与未接受治疗的患者相比，临床结果不良的风险仍然较低(神经功能改善，优势比2.67，95%可信区间1.61~4.40；功能良好，优势比2.23，95%可信区间1.16~4.29；住院死亡率，优势比0.30，95%可信区间0.13~0.65)。在完全和PS匹配的队列中，rt-PA的使用与出血性并发症的风险之间没有显著的相关性。静脉注射rt-PA治疗可以改善急性缺血性卒中的高龄患者(80岁)的临床结果，而不会显著增加出血并发症的风险。
The benefit of intravenous recombinant tissue plasminogen activator (rt-PA) therapy for very old patients with acute ischemic stroke remains unclear. The aim of this study was to elucidate the efficacy and safety of intravenous rt-PA therapy for patients over 80 years old. Of 13,521 stroke patients registered in the Fukuoka Stroke Registry in Japan from June 1999 to February 2013, 953 ischemic stroke patients who were over 80 years old, hospitalized within 3 h of onset, and not treated with endovascular therapy were included in this study. Among them, 153 patients were treated with intravenous rt-PA (0.6 mg/kg). For propensity score (PS)-matched case-control analysis, 148 patients treated with rt-PA and 148 PS-matched patients without rt-PA therapy were selected by 1∶1 matching with propensity for using rt-PA. Clinical outcomes were neurological improvement, good functional outcome at discharge, in-hospital mortality, and hemorrhagic complications (any intracranial hemorrhage [ICH], symptomatic ICH, and gastrointestinal bleeding). In the full cohort of 953 patients, rt-PA use was associated positively with neurological improvement and good functional outcome, and negatively with in-hospital mortality after adjustment for multiple confounding factors. In PS-matched case-control analysis, patients treated with rt-PA were still at lower risk for unfavorable clinical outcomes than non-treated patients (neurological improvement, odds ratio 2.67, 95% confidence interval 1.61–4.40; good functional outcome, odds ratio 2.23, 95% confidence interval 1.16–4.29; in-hospital mortality, odds ratio 0.30, 95% confidence interval 0.13–0.65). There was no significant association between rt-PA use and risk of hemorrhagic complications in the full and PS-matched cohorts. Intravenous rt-PA therapy was associated with improved clinical outcomes without significant increase in risk of hemorrhagic complications in very old patients (aged>80 years) with acute ischemic stroke.
登录
查看更多内容
DOI：
10.1136/bmj.c6046
发表时间：
2010-11-23
期刊：
BMJ (Clinical research ed.)
影响因子：
--
作者：
Mishra NK;Ahmed N;Andersen G;Egido JA;Lindsberg PJ;Ringleb PA;Wahlgren NG;Lees KR;VISTA collaborators;SITS collaborators
通讯作者：
SITS collaborators
影响因子：
8.3
作者：
Alshekhlee, Amer;Mohammadi, Afshin;Cruz-Flores, Salvador
通讯作者：
Cruz-Flores, Salvador
影响因子：
9.9
作者：
Engelter, ST;Reichhart, M;Lyrer, PA
通讯作者：
Lyrer, PA
影响因子：
8.3
作者：
Tanne, D;Gorman, MJ;Levine, SR
通讯作者：
Levine, SR
影响因子：
13.2
作者：
Matsuo, Seiichi;Imai, Enyu;Hishida, Akira
通讯作者：
Hishida, Akira