Intravenous thrombolysis in Acute Ischaemic Stroke: A systematic review and meta-analysis to aid decision making in patients over 80 years of age.
Résumé
Introduction: Patients ≥ 80 years of age are increasingly receiving intravenous thrombolysis for acute ischaemic stroke (AIS) despite lack of firm evidence. This systematic review assesses safety and efficacy of intravenous thrombolysis with alteplase in ≥ 80 vs. < 80 year old patients with AIS. Methods: The existing literature was systematically analysed for outcome measures of mortality, functional recovery by modified Rankin scale (mRS) and symptomatic intracranial haemorrhage (SICH) at three months following intravenous thrombolysis with alteplase in < 80 and ≥ 80 years old patients with AIS. Statistical tests were performed for heterogeneity and publication bias. A sensitivity analysis was performed and forest plot constructed for each of the outcome measures. Results: Thirteen studies were identified. The overall odds ratio (OR) was 2.77 (95% CI 2.25−3.40) for death, 0.49 (95% CI 0.40−0.61) for achieving favourable outcome and 1.31 (95% CI 0.93−1.84) for SICH in ≥ 80 years old patients, compared to those <80 years old. The total number of events contributing to the estimates of effect for each outcome was: death 199, favourable outcome 141 and SICH 49. Conclusion: Patients ≥ 80 years, appear to have a lower probability of gaining favourable outcome and a higher mortality rate as compared to patients <80 years old; however, the rate of SICH is not significantly increased. This supports recruitment of patients aged ≥ 80 into ongoing trials comparing thrombolysis with control. For patients who refuse or cannot be randomised, it provides information on risks and benefits of using alteplase off-licence.
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