Acute stroke management in the elderly
| Autor: | Isaac E Silverman, Louise D. McCullough, Jyoti Chhabra, Nora Lee, Neer Zeevi |
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| Rok vydání: | 2006 |
| Předmět: |
Male
medicine.medical_specialty Time Factors Stroke patient MEDLINE Severity of Illness Index Brain Ischemia Cohort Studies Fibrinolytic Agents Severity of illness medicine Humans Thrombolytic Therapy cardiovascular diseases Intensive care medicine Stroke Acute stroke Aged Retrospective Studies Aged 80 and over business.industry Patient Selection Age Factors Retrospective cohort study Community Health Centers Middle Aged medicine.disease Recombinant Proteins Intra arterial thrombolysis Connecticut Transportation of Patients Treatment Outcome Neurology Tissue Plasminogen Activator Acute Disease Practice Guidelines as Topic Female Neurology (clinical) Cardiology and Cardiovascular Medicine business Cohort study |
| Zdroj: | Cerebrovascular diseases (Basel, Switzerland). 23(4) |
| ISSN: | 1015-9770 |
| Popis: | Background and Purpose: Though the proportion of elderly stroke patients is increasing, patients >80 years are often excluded from clinical stroke trials. We reviewed the management of older patients presenting with acute ischemic stroke (AIS) and assessed the safety and efficacy of recombinant tissue plasminogen activator (rtPA) administration in a community-based setting. Methods: A retrospective review of patients >80 years (n = 341) admitted to a community stroke center with AIS were compared to their younger counterparts (n = 690) using the stroke center database from April 2003 to December 2005. Parameters that were measured included admission and discharge NIH Stroke Scale (NIHSS), rate of thrombolytic treatment, the frequency and etiology of thrombolytic exclusion criteria and complications from rtPA for the different aged populations. Additional data were collected for Barthel Index at 12 months. Results: A total of 166 patients underwent thrombolysis. Older patients were not delayed in reaching the hospital within 3 h of stroke onset (182/690, 26%, in the Conclusions: Early treatment with rtPA in patients >80 years appears to be both safe and efficacious. Treated patients showed improvements both acutely (a decrease in NIHSS at 72 h) and chronically, as shown by a sustained improvement in the Barthel Index. A large number of elderly patients were excluded from rtPA treatment despite arriving within the time frame of treatment for reasons not considered as traditional exclusion criteria. Older patients with AIS can be treated safely with thrombolytic therapy in a community setting. This therapy should not be withheld on the basis of age. |
| Databáze: | OpenAIRE |
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