80세 이상 뇌졸중 환자군에서 rtPA를 사용한 환자군과 80세 미만에서 사용한 환자군 사이의 예후 및 합병증 발생에 대한 비교

Abstract

ABSTRACT

Differences of prognosis and complications between over and under 80 years old ischemic stroke patients who received rt-PA

Wook Hur Advisor : Prof. Choo In sung M.D. Department of Medicine, Graduate School of Chosun University

Objectives Proportion of elderly patients is gradually increasing in republic of Korea. But, intravenous recombinant tissue plasminogen activator (rt-PA) therapy is recently not recommanded in elderly acute ischemic stroke patinets, although old age is not a proven contraindication to intravenously rt-PA. The purpose of this study was to investigate the safety and prognosis of intravenous thrombolysis in elderly patients.

Methods We enrolled 172 patients, who received intravenous rt-PA according to protocol of the American heart association guidelines, in Chosun university hospital, from January 2008 to January 2013. The patients was devided into under 80 and over 79 years(elderly patients) group. We assessed clinical course and improvement by national institutes of health stroke scale score(NIHSS), modified Rankin score(mRS) at admission, discharge, 3 moths later. And comparison of intracranial hemorrhage between two groups after intravenous thrombolysis was investigated. All clinical data were compared between these two groups.

Results Of the total 172 patients, 54(31.4%) patients were 80 years or older. Symptomatic hemorrhage and asymptomatic hemorrhage was not different between both groups [over 79 years patients: 4/54 (7.4%) vs. under 80 years patients: 10/118 (8.5%), P>0.302], [16.7% vs. 17.7%, P>0.701]. There were no difference in mortality and favorable prognosis at 3 months later between both groups [over 79 years patients: 5/54 (9.3%) vs. nder 80 years patients: 5/118 (4.2%), P=0.290], [over 79 years patients: 13/21 (24.1%) vs. under 80 years patients: 56/86 (47.5%), P=0.803]. There was difference in early neurological improvement rate(improvement > NIHSS 3) and degree of improvement (NIHSS at discharge - NIHSS at admission) were significant[over 79 years patients: 24/54 (44.4%) vs. under 80 years patients: 77/118 (65.8%), P=0.012], [2.69 vs 5.55, P=0.017].

Conclusion Intracranial hemorrhage(symptomatic and asymptomatic) and favorable prognosis are not different significantly between two groups. Elderly patients is not a absolute contraindication for intravenous thrombolysis. For intravenous thrombolysis in elderly ischemic stroke patients, we need more study to exclude the poor prognostic factors and to consider of gain of patients.

KEY WORDS : Ischemic stroke, Tissue plasminogen activator, Elderly.