Age No Bar to Thrombolysis for Stroke in Octogenarians
Neurology 2005;65:1795-1798.
By David Douglas
NEW YORK (Reuters Health) Dec 29 - Although elderly stroke patients have a greater risk of dying following therapy with IV recombinant tissue plasminogen activator (rtPA), age is not an independent predictor of outcome, Swiss researchers report in the December 13th issue of Neurology.
Dr. S. T. Engelter of University Hospital Basel and colleagues came to this conclusion after studying 325 rtPA-treated stroke patients. Of these, 38 were 80 years of age or more and the remaining 287, who ranged in age from 14 to 79 years, had a mean age of 63 years.
The rate of intracranial hemorrhage did not differ between the two groups and overall there was a favorable outcome in 29% of the older patients and 37% of the younger patients. At 3 months, 32% of the elderly patients had died compared with 12% of the younger patients.
Among patients who survived for 3 months, the rate of favorable outcome was 42% in the older patients and 43% in the younger patients.
"Logistic regression showed that stroke severity, time to thrombolysis, glucose level, and history of coronary heart disease independently predicted outcome, whereas age did not," the researchers report.
Commenting on the findings, Dr. J. Claude Hemphill III, co-author of an accompanying editorial told Reuters Health, "IV rt-PA should not be withheld from acute stroke patients just because they are very old."
Dr. Hemphill of the University of California, San Francisco, added that "while older patients might have a higher risk of bleeding from rt-PA, we know that older patients also are more likely to die and less likely to recover from the stroke itself."
在80岁老年人中，中风后行溶栓术无年龄禁忌。
瑞士科学家在12月的第13期神经病学杂志上报道说，尽管老年中风病人在静脉行重组组织型纤维蛋白酶原激活剂治疗存在更大的死亡危险，但年龄并不是影响预后的唯一因素。
Engelte大学巴塞而医院的Dr. S. T及其同事在研究了325名经tpa治疗的中风病人后得出这一结论。其中有38名病人年龄超过80岁，其它287名病人年龄在14到79岁之间，平均年龄为63岁。在两组病人中颅内出血率无明显差别，在29％的老年病人及37％的较年轻病人总体治疗结果良好。在3个月时，有32％的老年病人死亡，年轻病人死亡率为12％。在存活3个月病人中，42％的老年病人，43％的年轻病人结果良好。
报道称，Logistic回归分析显示，中风严重程度、溶栓治疗时间、血糖水平和冠心病病史能直接影响结果，但年龄却不会。
有关这些结果的评论，该报道的合作者Dr. J. Claude Hemphill III告诉路透社，静脉行tpa治疗不应该在急性中风病人中被禁止，仅仅因为他们太老的缘故。
旧金山加利福尼亚大学的 Hemphill博士补充说，尽管老年病人行tpa治疗会有更高的出血率，但同时应知道老年病人中风后有更高的死亡率，恢复的可能性也更小。
