Treating stroke patients older than age 80 with intravenous tissue plasminogen activator (IV-tPA) continues to be a controversial topic, primarily due to its perceived association with increased rates of intracranial hemorrhage (ICH).
Reliable analysis of robust datasets from the Safe Implementation of Treatment in Stroke-International Stroke Thrombolysis Register (SITS-ISTR) has shown that, in fact, IV-tPA patients older than age 80:
(1) do not have increased risk for clinically significant ICH,
(2) have early clinical improvement similar to younger patients, and
(3) have poor outcomes related to increased mortality (odds ratio 30% versus 12%), rather than
to higher rates of functional dependence (i.e. Modified Rankin Score 3 to 5).
References
Ford et al. Intravenous Alteplase for Stroke in Those Older Than 80 Years Old. Stroke November 2010; 41(11).
