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Initial licenses for use of intravenous recombinant tissue plasminogen activator (rt-PA) in stroke restricted its use to patients aged <80 years who could be treated within 3 hours of onset. In 2008, a European trial showed that treatment up to 4.5 hours after symptom onset in patients <80 years was also beneficial (JW Emerg Med Sep 24 2008). Patients aged >80 were rare in all prior trials.
The multicenter, randomized, placebo-controlled Third International Stroke Trial (IST-3) had no age exclusion and extended the window for treatment to 6 hours. Of 3035 patients enrolled over 11 years, 53% were aged >80. The primary outcome was the proportion of patients who were alive and independent at 6 months, as measured by the Oxford Handicap Score (…