Characteristics, temporal trends, and outcomes of intravenous thrombolysis in stroke patients aged > 80 years in China

Background/PurposeNo large cohort study has examined intravenous thrombolysis (IVT) in Chinese patients aged > 80 years.We aim to evaluate temporal trends in alteplase use, clinical characteristics, and outcomes in acute ischemic stroke (AIS) patients over 80 years of age in China. MethodsData were collected from The China Stroke Center Alliance program, which is a nationwide, multicenter, prospective registry at 1751 hospitals in 31 provinces, between January 1, 2018, and December 14, 2022.The primary outcome was a modified Rankin scale score (mRS) of 0-2 at discharge, and the secondary study outcomes were an mRS score 0-1 and independent ambulation at discharge. The safety outcomes included in-hospital mortality and symptomatic intracranial hemorrhage(sICH). ResultsOf 212,814 patients eligible for thrombolysis, 30,902 patients were aged > 80 years; among them, 8,673 patients (median [IQR] age, 84 [82-87] years) were treated with alteplase, 52.7% of whom were female (n=4570). The usage rate of alteplase in elderly patients increased from 22.1% in 2018 to 35.7% in 2022, while the rate among younger patients increased from 30.5% in 2018 to 43.3% in 2022. Patients treated with alteplase had better short-term functional outcomes, including mRS scores 0-2 (adjusted OR [aOR] 1.13, 95% CI 1.08-1.19, p<0.001), mRS scores 0-1 (aOR 1.14, 95% CI 1.09-1.20, p<0.001), and independent ambulation at discharge (aOR 1.27, 95% CI 1.19-1.39, p<0.001). Furthermore, there was no increased risk of in-hospital mortality (aOR 0.92, 95% CI 0.79-1.08, p=0.31). However, alteplase was associated with a higher risk of sICH (aOR 2.85, 95% CI 2.48-3.27, p<0.001). ConclusionsElderly patients receiving IVT with alteplase had better short-term functional outcomes without an increased risk of in-hospital mortality; however, elderly patients are at higher risk of developing symptomatic intracranial hemorrhage.