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Thrombolysis, stroke-unit admission and early rehabilitation in elderly patients

Abstract

Few elderly patients have been included in randomized trials assessing recombinant tissue plasminogen activator (rtPA) in stroke. In North America, intravenous thrombolysis is allowed in these patients; however, the European Medicines Agency does not recommend rtPA for the treatment of stroke in patients over 80 years of age. The influence of age on outcome following stroke-unit care and rehabilitation also remains controversial. In the absence of randomized trials, the efficacy of thrombolysis in elderly patients is difficult to measure. The majority of rtPA cohort studies demonstrate that patients over 80 years of age have lower rates of positive outcomes following treatment than younger patients. These studies are, however, reassuring with regard to the risk of symptomatic intracerebral hemorrhage and death, and suggest that rtPA can be safely administered to carefully selected elderly patients within 3 h of the onset of stroke. Further randomized studies will lead to more-accurate conclusions about the efficacy and safety of rtPA in the elderly subgroup. Admission to a stroke unit rather than to a general ward and early rehabilitation are justified in elderly patients. In this article, we review the literature regarding the effect of thrombolysis, stroke-unit care, and rehabilitation in patients over 80 years of age with stroke.

Key Points

  • Elderly patients constitute 30% of all patients with ischemic stroke; however, such individuals are at risk of receiving suboptimal care

  • Patients aged 80 years or over with stroke have a substantially higher mortality risk than younger patients and are less likely to make a favorable recovery

  • Intravenous thrombolysis, using recombinant tissue plasminogen activator, is safe and potentially effective in patients aged 80 years or over with stroke; however, data from randomized placebo-controlled studies are lacking in this subgroup

  • Admission to a stroke unit is beneficial across all age ranges, and is associated with reductions in the probabilities of death, disability, and institutionalization

  • Rehabilitation might be more challenging in elderly patients with stroke than in younger individuals, but no evidence exists to suggest that age alone should influence decisions on eligibility for rehabilitation

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Acknowledgements

The authors would like to thank Miss Frédérique Groga-Bada for her help in the preparation of this manuscript.

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Derex, L., Nighoghossian, N. Thrombolysis, stroke-unit admission and early rehabilitation in elderly patients. Nat Rev Neurol 5, 506–511 (2009). https://doi.org/10.1038/nrneurol.2009.127

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