Analysis of the efficacy and safety of recombinant tissue plasminogen activator for Chinese patients over 80 years of age with acute ischemic stroke : a pilot study

Recombinant tissue plasminogen activator (rt-PA) remains the only proven therapy for acute ischemic stroke patients who meet the selection criteria for treatment [1-3]. A small number of studies have investigated the efficacy of rt-PA for elderly stroke patients in Japanese and Caucasian populations [4, 5]. According to the American Heart Association/American Stroke Association Guidelines, patients over 80 years of age can be selected for rt-PA thrombolysis [6] and the Third International Stroke Trial found that the benefit of rt-PA did not diminish in patients older than 80 years [7]. However, the Chinese Guidelines for Stroke Management do not recommend rt-PA thrombolysis for these patients, due to the possibility that it increases the risk of intracranial hemorrhage transformation and subsequent nosocomial mortality [8]. In addition, an epidemiological study in Europe showed that >30% of the people included in their study who were >80 years old developed ischemic stroke after rt-PA treatment [5]. In China, there have been no such studies. Therefore, there is a urgent need to confirm the safety and efficacy of rt-PA in these patients [4, 5]. The present study aimed to reveal whether rt-PA could be safely and efficiently used on Chinese patients >80 years old with acute ischemic stroke. To do this, measures of safety and neurological function of these patients after rt-PA thrombolysis were compared with their younger counterparts (60-80 years) who also received rt-PA thrombolysis and patients >80 years old who did not receive rt-PA thrombolysis.