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Critical Care |

Thrombolytic Therapy in Ischemic Stroke Patients Over 80 Years of Age

Farzin Rahmanou*, DO; Edison Gavilanes, MD; Anirban Basu, MD; Chris Cheng, MD; Susan Denn, PA-C; Edward Chai, MD; Melvin Hochman, MD; Cristina Gutierrez, MD
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New York Hospital of Queens, Flushing, NY


Chest. 2012;142(4_MeetingAbstracts):372A. doi:10.1378/chest.1389247
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Abstract

SESSION TYPE: Neuro Critical Care

PRESENTED ON: Tuesday, October 23, 2012 at 04:30 PM - 05:45 PM

PURPOSE: To evaluate the impact and safety of tPA for ischemic stroke (IS) in patients 80 years old (yo) and older.

METHODS: : We retrospectively reviewed charts of patients greater than 80 yo who received tPA for IS from June 2006-February 2012. Demographics and clinical data included age, gender, Charles-Deyo comorbidity index(CCI), blood pressure(BP), blood sugar(BS), platelet count(PLT), and NIHH, MSS, and HAT scores at the time of tPA administration. Outcomes included Modified Rankin scale(MRS) on discharge, intracranial hemorrhage(ICH), ICU/hospital length of stay(LOS), mortality, and disposition. T-test, Chi-square, Cochran-Armitage Trend Test, and AUC were employed to analyze the data using SAS9.3(Cary, NC).

RESULTS: 58 patients greater than 80 yo received tPA for IS during this period. Most patients were female(75%), Caucasian(49%), had few co-morbidities (CCI=1.8), and good functional status(MRS=1.8). Time to administration of tPA, BP, and PLT, were within guideline recommendations. 27%(n=16) of patients developed ICH. There were no differences in demographics, NIHH score, PLT, BS, or BP between patients with ICH and no-ICH. However, there was a trend towards increased risk of ICH with longer time to t-PA administration (124min vs.154min;p=0.057). MRS on discharge, ICU/hospital LOS, and mortality were not different between the two groups. MSS score, but not HAT score, was significantly higher in the ICH group when compared to no-ICH(2.6 vs.2.2;p=0.0204,AUC0.67). Moreover, patients with a higher MSS(≥3) were at higher risk of ICH(45%) when compared to scores of 2 (21%) or 1 (0%) (p=0.02,Cochran-Armitage test).

CONCLUSIONS: In our study, patients older than 80 yo who received tPA for IS had a higher incidence of ICH and overall mortality when compared to what is described in the literature. Moreover, their MSS score could possibly be a good predictor for ICH.

CLINICAL IMPLICATIONS: MSS score could possibly be a good predictor for ICH in octogenarians; nonetheless, a larger population is needed to further evaluate this score as a tool for tPA administration for IS in patients greater than 80 yo.

DISCLOSURE: The following authors have nothing to disclose: Farzin Rahmanou, Edison Gavilanes, Anirban Basu, Chris Cheng, Susan Denn, Edward Chai, Melvin Hochman, Cristina Gutierrez

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New York Hospital of Queens, Flushing, NY

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