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KMID : 0858420110130020079
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Korean Journal of Stroke
2011 Volume.13 No. 2 p.79 ~ p.84
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The Factors Associated with the Decision of r-tPA Use in Acute Ischemic Stroke Patients
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Jeong Min-Gyeong
Kim Ye-Rim
Kim Yeo-Jin
Oh Mee-Sun
Yu Kyung-Ho
Lee Byung-Chul
Lee Ju-Hun
Kwon Jee-Hyun
Kwon Sun-Uck
Heo Sung-Hyuk
Choi Jay-Chol
Kwon Hyung-Min
Park Jong-Moo
Kim Eung-Gyu
Rha Joung-Ho
Park Hee-Kwon
Bae Hee-Joon
Han Moon-Ku
Hong Keun-Sik
Cho Yong-Jin
Park Man-Seok
Cho Ki-Hyun
Kim Hahn-Young
Lee Jun
Kim Dong-Eog
Lee Soo-Joo
Lee Kyung-Bok
Park Tae-Hwan
Cha Myoung-Jin
Heo Ji-Hoe
Nam Hyo-Suk
Cha Jae-Kwan
Kim Chul-Ho
Yoon Byung-Woo
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Abstract
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Background: Small proportions of all the elderly stroke patients receive recombinant tissue plasminogen activator (r-tPA) therapy,although old age is not a proven contraindication to intravenous thrombolytic therapy for acute ischemic stroke. The purpose of this study was to identify reasons for exclusion from r-tPA therapy and factors associated with the decision of r-tPA use in elderly patients with acute ischemic stroke.
Methods: From the acute stroke registries of 22 domestic university hospitals taking the r-tPA therapy from January 2007 to May 2010, we extracted data of all acute ischemic stroke patients who were aged 80 or over and arrived within onset 3 hours. For all patients, we assessed the eligibility of r-tPA therapy using National Institute of Neurological Disorders and Stroke (NINDS) r-tPA trial criteria. For eligible patients, we compared all clinical variables between patients who were treated with r-tPA and those who were not, and analyzed potential factors related to the decision of r-tPA use.
Results: A total of 494 patients were included in this study. 255 patients (51.6%) were excluded by NINDS r-tPA trial criteria and the major reasons for exclusion were minor neurological defi cit (53.7%) and clinical improvement (17.3%). Among 239 patients who were eligible for r-tPA, 162 (32.8%) patients received r-tPA and 77 (15.6%) did not. Multivariable analysis showed that younger age, shorter time-delay from onset to admission, non-smoker, no history of prior stroke, good pre-stroke functional status and severe initial neurological defi cit were independently associated with the decision of r-tPA use in the elderly stroke patients predictors for r-tPA treatment.
Conclusion: In very elderly patients, mild neurological defi cit on arrival and rapid clinical improvement in neurological symptoms were the main reasons for exclusion from thrombolytic therapy.
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KEYWORD
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Stroke, Thrombolysis, Tissue plasminogen activation, Elderly, Exclusion
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