• Réza Behrouz, Jaime Masjuán-Vallejo, Rocío Vera, Joshua Z Willey, Mickael Zedet, Solène Moulin, Charlotte Cordonnier, KlijnCatharina J MCJMCentre for Cognitive Neuroscience, Department of Neurology, Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands., Karin Kanselaar, Maaike Dirks, Brian Silver, Muhib Khan, Mahmoud R Azarpazhooh, Daniel A Godoy, Christine Roffe, Lizz Paley, Benjamin D Bray, Craig J Smith, Mario Di Napoli, and ITAS-90+ Collaborative.
• Department of Neurology, School of Medicine, University of Texas Health Science Center, San Antonio, Texas. Electronic address: behrouz@uthscsa.edu.
• J Stroke Cerebrovasc Dis. 2018 Jan 1; 27 (1): 246-256.

BackgroundNonagenarians are under-represented in thrombolytic trials for acute ischemic stroke (AIS). The effectiveness of intravenous thrombolytics in nonagenarians in terms of safety and outcome is not well established.Materials And MethodsWe used a multinational registry to identify patients aged 90 years or older with good baseline functional status who presented with AIS. Differences in outcomes-disability level at 90 days, frequency of symptomatic intracerebral hemorrhage (sICH), and mortality-between patients who did and did not receive thrombolytics were assessed using multivariable logistic regression, adjusted for prespecified prognostic factors. Coarsened exact matching (CEM) was utilized before evaluating outcome by balancing both groups in the sensitivity analysis.ResultsWe identified 227 previously independent nonagenarians with AIS; 122 received intravenous thrombolytics and 105 did not. In the unmatched cohort, ordinal analysis showed a significant treatment effect (adjusted common odds ratio [OR]: .61, 95% confidence interval [CI]: .39-.96). There was an absolute difference of 8.1% in the rate of excellent outcome in favor of thrombolysis (17.4% versus 9.3%; adjusted ratio: .30, 95% CI: .12-.77). Rates of sICH and in-hospital mortality were not different. Similarly, in the matched cohort, CEM analysis showed a shift in the primary outcome distribution in favor of thrombolysis (adjusted common OR: .45, 95% CI: .26-.76).ConclusionsNonagenarians treated with thrombolytics showed lower stroke-related disability at 90 days than those not treated, without significant difference in sICH and in-hospital mortality rates. These observations cannot exclude a residual confounding effect, but provide evidence that thrombolytics should not be withheld from nonagenarians because of age alone.Copyright © 2018 National Stroke Association. Published by Elsevier Inc. All rights reserved.

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