A new study has unveiled valuable insights for treating elderly patients suffering from acute ischemic stroke who undergo intravenous thrombolysis, potentially changing clinical practices significantly for this vulnerable population. Researchers have developed and validated prediction models aimed at determining the risk of poor outcomes among patients over 80 years of age. This timely research addresses the growing medical needs of an aging population, which is projected to grow rapidly as life expectancy increases.
Intravenous thrombolysis (IVT) has been established as an effective treatment for acute ischemic stroke, primarily using the drug alteplase. Traditionally, there have been concerns about administering thrombolysis to older patients due to potential risks, including intracranial hemorrhage and poor functional recovery. Recent studies advocate for the use of thrombolysis even for those aged 80 and older, yet there has been insufficient focus on determining which patients are most likely to benefit from the treatment.
This research, conducted by clinicians at the West Coast New Area People's Hospital of Qingdao, China, involved analyzing 615 acute stroke patients who received thrombolysis between January 2018 and June 2022. The study focused particularly on two age groups: patients aged 60 to 79 and those aged 80 years and above.
The results showed alarming trends. Patients aged 80 and older had significantly higher rates of poor outcomes and mortality within 90 days of treatment compared to their younger counterparts. Specifically, statistical evaluations revealed the elderly group experienced higher scores on the National Institutes of Health Stroke Scale (NIHSS) upon admission, indicating more severe symptoms compared to patients aged 60 to 79. The data pointed to baseline NIHSS scores and admission blood glucose levels as key independent predictors of poor prognosis at the 90-day mark following thrombolysis.
Dr. Ying Wang, one of the study's authors, emphasized the importance of risk assessments for elderly patients before thrombolysis procedures. “The baseline NIHSS score and admission blood glucose could significantly guide clinical decision-making,” Wang noted. The study concluded with the development of a novel online prognostic tool available at [80IVTR Prognostic Calculator](https://80ivtr.shinyapps.io/dynnomapp/), intended for use by healthcare professionals when assessing elderly stroke patients' treatment options.
While the short-term results raised concerns, the study also provided insights concerning the duration of benefits from thrombolysis. Analysis revealed no significant improvements were registered for elderly patients beyond the 180-day mark. This contrasts with younger patients, who continued to show neurological improvement for at least one year post-treatment.
The research also delved deeply to understand factors influencing outcomes. It found no significant increase in symptomatic intracranial hemorrhage between the two age groups within the 24-hour post-treatment interval, which challenges prior assumptions of elevated bleeding risks associated with older patients receiving thrombolytics.
Notably, the findings suggest the beneficial effects of thrombolysis last about 180 days for patients aged 80 and older, which present physicians and families with meaningful information when weighing treatment options for elderly stroke sufferers. Dr. Lin Yin, co-author of the study, highlighted: “The study provides insights we have long needed to make informed decisions about the use of thrombolysis for our older adults.”
With the population aged over 80 years continuing to grow, this research serves as pivotal guidance for healthcare providers. Patients diagnosed with acute ischemic stroke at this advanced age can see treatment outcomes predicted more accurately, thanks to easily assessable metrics readily available at admission.
The study has also prompted discussions about the importance of risk-benefit evaluations when considering IV thrombolysis for elderly patients. Wang remarked, “Being able to predict the likely outcomes enables clinical professionals to engage more effectively with patients and their families, delivering dignity and respect to their choices.”
This groundbreaking research advocates for heightened awareness and improved practices within the clinical management of acute ischemic stroke among elderly populations. It urges medical professionals to rethink assumptions about age and treatment, potentially paving the way for more inclusive protocols as the field continues to evolve.