Intravenous rt-PA therapy for aged in regional hospitals

Abstract

Background and Purpose: There is still a regional difference in the treatment for acute ischemic stroke in Japan. We examined our medical system and results of intravenous recombinant tissue plasminogen activator for this disease at our hospital located in the provinces. Methods: The key of our medical system is the cooperation of physicians and exclusive nurses. We compared neurologic improvement within 24 hours, intracranial hemorrhage within 36 hours, and outcome (mortality and modified Rankin Scale at 3 months) of 14 patients ≥81 years of age with 18 patients ≤80 years of age. Results: Our medical system worked well without problem. There was no difference between the two age groups in the incidence of neurologic improvement, intracerebral hemorrhage, and mortality. The patients ≥81 years of age reduced independence (mRS 0–1, 0% versus 44.4%; p=0.004), however, one-fifth still maintained their ADL (mRS 0–2, 21.4% versus 44.4%; p=0.163). Conclusions: It is important to construct their own medical system. It was suggested that patients ≥81 years of age fulfilling the criteria for intravenous rt-PA can be candidates for this treatment.