Intravenous thrombolysis for stroke

Intravenous thrombolytic treatment for acute ischaemic stroke is controversial in patients over 80 years, mainly because they have been excluded from or under-represented in the large scale randomised controlled trials of such treatment.1 2 3 In the linked study (doi:10.1136/bmj.c6046), Mishra and colleagues assess the influence of age on the response to thrombolysis (alteplase) in people with acute ischaemic stroke⇓.4

Contrary to the recommendations and conditions for use in North America, the European Medicines Agency (EMEA) does not approve intravenous thrombolysis with recombinant tissue plasminogen activator in patients over 80 years with acute ischaemic stroke. This has important consequences: as the proportion of elderly people is rising in developed countries, 20-30% of patients with acute ischaemic stroke may be excluded from receiving the only curative emergency treatment available.5 6 7 In practice, the exclusion of patients on the grounds of age alone, along with poor public awareness of the stroke …