Thrombolysis for Stroke in Elderly in the Late Window Period

Objectives: Safety of intravenous thrombolysis (IVT) within 3-4.5 hours of stroke onset in patients >= 80 years is still disputable. We evaluated the association of symptom onset-to-treatment time (SOTT) with the symptomatic intracranial hemorrhage (sICH), poor outcome, and mortality in patients >= 80 years. Materials and Methods: In a retrospective study, patients treated with IVT following stroke were registered. Outcomes were poor outcome (mRS>2), sICH/ECASS-2, and in-hospital mortality. We compared the patients >= 80 years who received IVT within 3 hours with those receiving IVT within 3-4.5 hours. We further compared the patients who were <80 years with those >= 80 years and SOTT of 3-4.5 hours. Results: Of 834 patients, 265 aged over 80. In those above 80 and in multivariable analysis, the associations of SOTT with poor outcome (aOR: 1.401, CI: 0.503-3.903, p=0.519), sICH (aOR=2.50, CI=0.76-8.26, p=0.132) and mortality (aOR=1.12, CI=0.39-3.25, p=0.833) were not significant. 106 patients received IVT within 3-4.5 hours. In multivariable analysis, the associations of age (>= 80 versus <80) with poor outcome (aOR=1.87, CI=0.65-5.37, p= 0.246), sICH (aOR=0.65, CI= 0.14-3.11, p= 0.590), and mortality (aOR= 0.87, 95% CI=0.16-4.57, p=0.867) were not significant in patients with SOTT of 3-4.5 hours. Conclusion: IVT within 3-4.5 hours in patients >= 80 years is not associated with increased sICH, poor outcome, and mortality compared to the early time window, and also compared to the younger patients in 3-4.5 hours window period. The decision of IVT administration in this age group should not be made solely on the basis of stroke onset timing.