Effectiveness of thrombolysis with intravenous alteplase for acute ischemic stroke in older adults.

To the Editor: Thrombolysis with intravenous alteplase is widely accepted as an effective treatment for individuals with acute ischemic stroke, but few individuals aged 80 and older are treated with alteplase. The risk:benefit ratio of thrombolysis might be less favorable with older age because of a higher risk of adverse events and lower efficacy. Outcomes in older adults treated with alteplase has been studied mostly in comparison with younger individuals, but to reach a firm conclusion concerning the appropriateness of treating older adults with thrombolysis, one should also contrast treatment with no treatment. Individuals aged 80 and older with stroke have a higher casefatality rate, longer hospitalization, and are less likely to be discharged home than younger individuals. The results of a recent collaborative project suggest that individuals aged 80 and older derive similar benefit from treatment with intravenous alteplase as younger individuals. The aim of the present study was to assess the effectiveness of thrombolysis in relation to age in an unselected prospective observational cohort, in which all individuals with an ischemic stroke admitted within 4 hours of symptom onset were registered.