Benefits of r-tPA for Acute Ischemic Stroke Not Limited by Age

Carefully selected acute ischemic stroke patients >80 years old receiving r-tPA within 4.5 hours have improved outcomes and similar mortality.

Patients aged 80 and older represent one third of ischemic stroke cases. Although U.S. regulations have no age restrictions on use of r-tPA, Europe (until recently) had restricted its use to patients younger than 80. Such discrepancies, and sparse safety data, may contribute to undertreatment of elderly patients with stroke-like symptoms.

In an industry-sponsored pooled analysis of seven randomized controlled trials of r-tPA (6035 patients), researchers compared outcomes between the subsets of 2405 patients ≤80 years and 1028 older patients who met European r-tPA eligibility guidelines, other than age (last known normal <4.5 hours; NIH Stroke Scale score ≤25; systolic blood pressure [BP] ≤185 mm Hg; diastolic BP ≤110 mm Hg; glucose 50–400 mg…

Reviewing Author

Jason T. McMullan, MD, MS, FAEMS

Disclosures

Consultant/Advisory BoardEMCREG International

Grant/Research SupportNIH; Department of Defense

Editorial BoardsJournal of Emergency Medical Services

Leadership Positions in Professional SocietiesNational Association of EMS Physicians (Chair, Research Committee)