Older Age Does Not Increase Risk of Hemorrhagic Complications after Intravenous and/or Intra-Arterial Thrombolysis for Acute Stroke

Svetlna Pundik, Laurie McWilliams-Dunnigan, Kristine L. Blackham, H. L. Kirchner, Sophia Sundararajan, Jeffrey L. Sunshine, Robert W. Tarr, Warren R. Selman, Dennis M. Landis, Jose Suarez

Research output: Contribution to journalArticle

Abstract

Background: The elderly have significantly higher incidence of ischemic stroke and have higher mortality and morbidity compared with younger patients. Intracranial hemorrhage (ICH) after thrombolysis is one of the causes of unfavorable outcome. However, it is unclear whether age over 80 years is a predictor for hemorrhagic transformation after intravenous, intra-arterial, or a combination of both thrombolytic therapies. Methods: A database of 488 consecutive patients with ischemic stroke who received thrombolytic therapy was analyzed using logistic regression model to determine whether factors such as age over 80 years, demographic characteristics, onset to treatment time, severity of neurologic deficits, route of administration, blood glucose, or mean arterial pressure were associated with symptomatic ICH. Results: The rates of symptomatic hemorrhage were 12.82% and 10.4% in older and younger groups, respectively. The odds of symptomatic hemorrhage after thrombolytic therapy for patients over 80 years of age after adjusting for route of administration, National Institutes of Health Stroke Scale score, mean arterial pressure, and glucose was not significantly different from that of the younger age group (odds ratio [OR] = 1.64; 95% confidence interval [CI]: 0.729-3.66). Hyperglycemia (>150 mg/dL) was associated with increased odds of symptomatic ICH (OR = 2.32; 95% CI: 1.09-4.93). Patients older than 80 years had similar rates of recanalization (OR = 0.8; 95% CI: 0.4-1.8) and rates of asymptomatic ICH (OR = 2.40; 95% CI: 0.89-6.5). Conclusions: Risks of ICH after thrombolysis for acute ischemic stroke are similar in patients over and under 80 years of age. Our data suggest that the decision to provide thrombolytic therapy should not be solely based on patient's age.

Original languageEnglish (US)
Pages (from-to)266-272
Number of pages7
JournalJournal of Stroke and Cerebrovascular Diseases
Volume17
Issue number5
DOIs
StatePublished - Sep 1 2008
Externally publishedYes

Fingerprint

Intracranial Hemorrhages
Stroke
Thrombolytic Therapy
Odds Ratio
Confidence Intervals
Arterial Pressure
Logistic Models
Hemorrhage
National Institutes of Health (U.S.)
Neurologic Manifestations
Hyperglycemia
Blood Glucose
Age Groups
Demography
Databases
Morbidity
Glucose
Mortality
Incidence

Keywords

  • acute
  • elderly
  • hemorrhage
  • intracranial
  • Stroke
  • therapeutic thrombolysis

ASJC Scopus subject areas

  • Surgery
  • Rehabilitation
  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine

Cite this

Older Age Does Not Increase Risk of Hemorrhagic Complications after Intravenous and/or Intra-Arterial Thrombolysis for Acute Stroke. / Pundik, Svetlna; McWilliams-Dunnigan, Laurie; Blackham, Kristine L.; Kirchner, H. L.; Sundararajan, Sophia; Sunshine, Jeffrey L.; Tarr, Robert W.; Selman, Warren R.; Landis, Dennis M.; Suarez, Jose.

In: Journal of Stroke and Cerebrovascular Diseases, Vol. 17, No. 5, 01.09.2008, p. 266-272.

Research output: Contribution to journalArticle

Pundik, S, McWilliams-Dunnigan, L, Blackham, KL, Kirchner, HL, Sundararajan, S, Sunshine, JL, Tarr, RW, Selman, WR, Landis, DM & Suarez, J 2008, 'Older Age Does Not Increase Risk of Hemorrhagic Complications after Intravenous and/or Intra-Arterial Thrombolysis for Acute Stroke', Journal of Stroke and Cerebrovascular Diseases, vol. 17, no. 5, pp. 266-272. https://doi.org/10.1016/j.jstrokecerebrovasdis.2008.03.003
Pundik, Svetlna ; McWilliams-Dunnigan, Laurie ; Blackham, Kristine L. ; Kirchner, H. L. ; Sundararajan, Sophia ; Sunshine, Jeffrey L. ; Tarr, Robert W. ; Selman, Warren R. ; Landis, Dennis M. ; Suarez, Jose. / Older Age Does Not Increase Risk of Hemorrhagic Complications after Intravenous and/or Intra-Arterial Thrombolysis for Acute Stroke. In: Journal of Stroke and Cerebrovascular Diseases. 2008 ; Vol. 17, No. 5. pp. 266-272.
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abstract = "Background: The elderly have significantly higher incidence of ischemic stroke and have higher mortality and morbidity compared with younger patients. Intracranial hemorrhage (ICH) after thrombolysis is one of the causes of unfavorable outcome. However, it is unclear whether age over 80 years is a predictor for hemorrhagic transformation after intravenous, intra-arterial, or a combination of both thrombolytic therapies. Methods: A database of 488 consecutive patients with ischemic stroke who received thrombolytic therapy was analyzed using logistic regression model to determine whether factors such as age over 80 years, demographic characteristics, onset to treatment time, severity of neurologic deficits, route of administration, blood glucose, or mean arterial pressure were associated with symptomatic ICH. Results: The rates of symptomatic hemorrhage were 12.82{\%} and 10.4{\%} in older and younger groups, respectively. The odds of symptomatic hemorrhage after thrombolytic therapy for patients over 80 years of age after adjusting for route of administration, National Institutes of Health Stroke Scale score, mean arterial pressure, and glucose was not significantly different from that of the younger age group (odds ratio [OR] = 1.64; 95{\%} confidence interval [CI]: 0.729-3.66). Hyperglycemia (>150 mg/dL) was associated with increased odds of symptomatic ICH (OR = 2.32; 95{\%} CI: 1.09-4.93). Patients older than 80 years had similar rates of recanalization (OR = 0.8; 95{\%} CI: 0.4-1.8) and rates of asymptomatic ICH (OR = 2.40; 95{\%} CI: 0.89-6.5). Conclusions: Risks of ICH after thrombolysis for acute ischemic stroke are similar in patients over and under 80 years of age. Our data suggest that the decision to provide thrombolytic therapy should not be solely based on patient's age.",
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T1 - Older Age Does Not Increase Risk of Hemorrhagic Complications after Intravenous and/or Intra-Arterial Thrombolysis for Acute Stroke

AU - Pundik, Svetlna

AU - McWilliams-Dunnigan, Laurie

AU - Blackham, Kristine L.

AU - Kirchner, H. L.

AU - Sundararajan, Sophia

AU - Sunshine, Jeffrey L.

AU - Tarr, Robert W.

AU - Selman, Warren R.

AU - Landis, Dennis M.

AU - Suarez, Jose

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N2 - Background: The elderly have significantly higher incidence of ischemic stroke and have higher mortality and morbidity compared with younger patients. Intracranial hemorrhage (ICH) after thrombolysis is one of the causes of unfavorable outcome. However, it is unclear whether age over 80 years is a predictor for hemorrhagic transformation after intravenous, intra-arterial, or a combination of both thrombolytic therapies. Methods: A database of 488 consecutive patients with ischemic stroke who received thrombolytic therapy was analyzed using logistic regression model to determine whether factors such as age over 80 years, demographic characteristics, onset to treatment time, severity of neurologic deficits, route of administration, blood glucose, or mean arterial pressure were associated with symptomatic ICH. Results: The rates of symptomatic hemorrhage were 12.82% and 10.4% in older and younger groups, respectively. The odds of symptomatic hemorrhage after thrombolytic therapy for patients over 80 years of age after adjusting for route of administration, National Institutes of Health Stroke Scale score, mean arterial pressure, and glucose was not significantly different from that of the younger age group (odds ratio [OR] = 1.64; 95% confidence interval [CI]: 0.729-3.66). Hyperglycemia (>150 mg/dL) was associated with increased odds of symptomatic ICH (OR = 2.32; 95% CI: 1.09-4.93). Patients older than 80 years had similar rates of recanalization (OR = 0.8; 95% CI: 0.4-1.8) and rates of asymptomatic ICH (OR = 2.40; 95% CI: 0.89-6.5). Conclusions: Risks of ICH after thrombolysis for acute ischemic stroke are similar in patients over and under 80 years of age. Our data suggest that the decision to provide thrombolytic therapy should not be solely based on patient's age.

AB - Background: The elderly have significantly higher incidence of ischemic stroke and have higher mortality and morbidity compared with younger patients. Intracranial hemorrhage (ICH) after thrombolysis is one of the causes of unfavorable outcome. However, it is unclear whether age over 80 years is a predictor for hemorrhagic transformation after intravenous, intra-arterial, or a combination of both thrombolytic therapies. Methods: A database of 488 consecutive patients with ischemic stroke who received thrombolytic therapy was analyzed using logistic regression model to determine whether factors such as age over 80 years, demographic characteristics, onset to treatment time, severity of neurologic deficits, route of administration, blood glucose, or mean arterial pressure were associated with symptomatic ICH. Results: The rates of symptomatic hemorrhage were 12.82% and 10.4% in older and younger groups, respectively. The odds of symptomatic hemorrhage after thrombolytic therapy for patients over 80 years of age after adjusting for route of administration, National Institutes of Health Stroke Scale score, mean arterial pressure, and glucose was not significantly different from that of the younger age group (odds ratio [OR] = 1.64; 95% confidence interval [CI]: 0.729-3.66). Hyperglycemia (>150 mg/dL) was associated with increased odds of symptomatic ICH (OR = 2.32; 95% CI: 1.09-4.93). Patients older than 80 years had similar rates of recanalization (OR = 0.8; 95% CI: 0.4-1.8) and rates of asymptomatic ICH (OR = 2.40; 95% CI: 0.89-6.5). Conclusions: Risks of ICH after thrombolysis for acute ischemic stroke are similar in patients over and under 80 years of age. Our data suggest that the decision to provide thrombolytic therapy should not be solely based on patient's age.

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