Iv Thrombolysis Is Not Associated With An Increased Risk Of Hemorrhage In Nonagenarians

OBJECTIVE: We sought to investigate the risk of intracerebral hemorrhage and safety of IV r-tPA in nonagenarians. BACKGROUND: There is scant data on the use of IV thrombolytics for acute ischemic stroke in the nonagenarian population. There is no recommended upper age limit to use IV r-tPA but there are concerns about the safety of IV thrombolysis and the risk of intracerebral hemorrhage in patients who are >90. As our population continues to age the number of nonagenarians seeking emergency care for acute ischemic stroke will increase. DESIGN/METHODS: We reviewed our stroke registry database of acute stroke codes and selected patients who were >90 years old and categorized them into those who received IV r-tPA and those who did not. We collected patient risk factors, baseline MRS, initial NIHSS, stroke subtype, follow up neuroimaging and discharge disposition. Discharge disposition of home or acute rehab was considered favorable. The primary outcome was intracerebral hemorrhage on follow up neuro-imaging. We used Fisher9s exact test and Mann-Whitney U when appropriate. RESULTS: Between February 2011 and August 2012, 7 patients >90 years old were treated with IV r-tPA. 8 patients >90 years old with confirmed ischemic strokes were not treated with IV r-tPA. The mean NIHSS in the thrombolysis group was 18.7 compared to 10.6 in the non-thrombolysis group (p=0.03). Despite the disparity, discharge disposition was comparable between the groups. Other baseline characteristics were similar between the two groups. One patient in the thrombolysis group had asymptomatic hemorrhage on follow up imaging (14.3%) versus 1 patient in the non-thrombolysis group (12.5%) (p=0.73). CONCLUSIONS: IV r-tPA treatment was not associated with a higher risk of hemorrhage in patients >90 years old. This may indicate safety of IV thrombolysis in this age group. Nonagenarians should not be excluded from thrombolysis based upon age alone. Further study is needed. Disclosure: Dr. Shafi has nothing to disclose. Dr. Khaja has nothing to disclose. Dr. Hoelzel has nothing to disclose. Dr. Grysiewicz has nothing to disclose. Dr. Testai has nothing to disclose. Dr. Ruland has received personal compensation for activities with AstraZeneca Pharmaceuticals and Boehringer Ingelheim Pharmaceuticals, Inc.