80세 이상 급성기 허혈뇌졸중 환자에서 정맥내 혈전 용해 치료를 결정하는데 연관된 요인
The Factors Associated with the Decision of r-tPA Use in Acute Ischemic Stroke Patients
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Background: Small proportions of all the elderly stroke patients receive recombinant tissue plasminogen activator (r-tPA) therapy,although old age is not a proven contraindication to intravenous thrombolytic therapy for acute ischemic stroke. The purpose of this study was to identify reasons for exclusion from r-tPA therapy and factors associated with the decision of r-tPA use in elderly patients with acute ischemic stroke. Methods: From the acute stroke registries of 22 domestic university hospitals taking the r-tPA therapy from January 2007 to May 2010, we extracted data of all acute ischemic stroke patients who were aged 80 or over and arrived within onset 3 hours. For all patients, we assessed the eligibility of r-tPA therapy using National Institute of Neurological Disorders and Stroke (NINDS) r-tPA trial criteria. For eligible patients, we compared all clinical variables between patients who were treated with r-tPA and those who were not, and analyzed potential factors related to the decision of r-tPA use. Results: A total of 494 patients were included in this study. 255 patients (51.6%) were excluded by NINDS r-tPA trial criteria and the major reasons for exclusion were minor neurological defi cit (53.7%) and clinical improvement (17.3%). Among 239 patients who were eligible for r-tPA, 162 (32.8%) patients received r-tPA and 77 (15.6%) did not. Multivariable analysis showed that younger age, shorter time-delay from onset to admission, non-smoker, no history of prior stroke, good pre-stroke functional status and severe initial neurological defi cit were independently associated with the decision of r-tPA use in the elderly stroke patients predictors for r-tPA treatment. Conclusion: In very elderly patients, mild neurological defi cit on arrival and rapid clinical improvement in neurological symptoms were the main reasons for exclusion from thrombolytic therapy. (Korean J Stroke 2011;13:79-84)
Abstract
Background: Small proportions of all the elderly stroke patients receive recombinant tissue plasminogen activator (r-tPA) therapy,although old age is not a proven contraindication to intravenous thrombolytic therapy for acute ischemic stroke. The purpose of this study was to identify reasons for exclusion from r-tPA therapy and factors associated with the decision of r-tPA use in elderly patients with acute ischemic stroke. Methods: From the acute stroke registries of 22 domestic university hospitals taking the r-tPA therapy from January 2007 to May 2010, we extracted data of all acute ischemic stroke patients who were aged 80 or over and arrived within onset 3 hours. For all patients, we assessed the eligibility of r-tPA therapy using National Institute of Neurological Disorders and Stroke (NINDS) r-tPA trial criteria. For eligible patients, we compared all clinical variables between patients who were treated with r-tPA and those who were not, and analyzed potential factors related to the decision of r-tPA use. Results: A total of 494 patients were included in this study. 255 patients (51.6%) were excluded by NINDS r-tPA trial criteria and the major reasons for exclusion were minor neurological defi cit (53.7%) and clinical improvement (17.3%). Among 239 patients who were eligible for r-tPA, 162 (32.8%) patients received r-tPA and 77 (15.6%) did not. Multivariable analysis showed that younger age, shorter time-delay from onset to admission, non-smoker, no history of prior stroke, good pre-stroke functional status and severe initial neurological defi cit were independently associated with the decision of r-tPA use in the elderly stroke patients predictors for r-tPA treatment. Conclusion: In very elderly patients, mild neurological defi cit on arrival and rapid clinical improvement in neurological symptoms were the main reasons for exclusion from thrombolytic therapy. (Korean J Stroke 2011;13:79-84)
참고문헌 (15)
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