80세 이상 급성기 허혈뇌졸중 환자에서 정맥내 혈전 용해 치료를 결정하는데 연관된 요인 (The Factors Associated with the Decision of r-tPA Use in Acute Ischemic Stroke Patients)

서지정보

· 발행기관 : 대한뇌졸중학회
· 수록지 정보 : 대한뇌졸중영문학회지 / 13권 / 2호 / 79 ~ 84페이지
· 저자명 : 정민경, 김예림, 김여진, 오미선, 유경호, 이병철, 이주헌, 권지현, 권순억, 허성혁, 최재철, 권형민, 박종무, 김응규, 나정호, 박희권, 배희준, 한문구, 홍근식, 조용진, 박만석, 조기현, 김한영, 이준영, 김동억, 이수주, 이경복, 박태환, 차명진, 허지회, 남효석, 차재관, 김철호, 윤병우

초록

Background: Small proportions of all the elderly stroke patients receive recombinant tissue plasminogen activator (r-tPA) therapy,although old age is not a proven contraindication to intravenous thrombolytic therapy for acute ischemic stroke. The purpose of this study was to identify reasons for exclusion from r-tPA therapy and factors associated with the decision of r-tPA use in elderly patients with acute ischemic stroke.
Methods: From the acute stroke registries of 22 domestic university hospitals taking the r-tPA therapy from January 2007 to May 2010, we extracted data of all acute ischemic stroke patients who were aged 80 or over and arrived within onset 3 hours. For all patients, we assessed the eligibility of r-tPA therapy using National Institute of Neurological Disorders and Stroke (NINDS) r-tPA trial criteria. For eligible patients, we compared all clinical variables between patients who were treated with r-tPA and those who were not, and analyzed potential factors related to the decision of r-tPA use.
Results: A total of 494 patients were included in this study. 255 patients (51.6%) were excluded by NINDS r-tPA trial criteria and the major reasons for exclusion were minor neurological defi cit (53.7%) and clinical improvement (17.3%). Among 239 patients who were eligible for r-tPA, 162 (32.8%) patients received r-tPA and 77 (15.6%) did not. Multivariable analysis showed that younger age, shorter time-delay from onset to admission, non-smoker, no history of prior stroke, good pre-stroke functional status and severe initial neurological defi cit were independently associated with the decision of r-tPA use in the elderly stroke patients predictors for r-tPA treatment. Conclusion: In very elderly patients, mild neurological defi cit on arrival and rapid clinical improvement in neurological symptoms were the main reasons for exclusion from thrombolytic therapy. (Korean J Stroke 2011;13:79-84)

영어초록

Background: Small proportions of all the elderly stroke patients receive recombinant tissue plasminogen activator (r-tPA) therapy,although old age is not a proven contraindication to intravenous thrombolytic therapy for acute ischemic stroke. The purpose of this study was to identify reasons for exclusion from r-tPA therapy and factors associated with the decision of r-tPA use in elderly patients with acute ischemic stroke.
Methods: From the acute stroke registries of 22 domestic university hospitals taking the r-tPA therapy from January 2007 to May 2010, we extracted data of all acute ischemic stroke patients who were aged 80 or over and arrived within onset 3 hours. For all patients, we assessed the eligibility of r-tPA therapy using National Institute of Neurological Disorders and Stroke (NINDS) r-tPA trial criteria. For eligible patients, we compared all clinical variables between patients who were treated with r-tPA and those who were not, and analyzed potential factors related to the decision of r-tPA use.
Results: A total of 494 patients were included in this study. 255 patients (51.6%) were excluded by NINDS r-tPA trial criteria and the major reasons for exclusion were minor neurological defi cit (53.7%) and clinical improvement (17.3%). Among 239 patients who were eligible for r-tPA, 162 (32.8%) patients received r-tPA and 77 (15.6%) did not. Multivariable analysis showed that younger age, shorter time-delay from onset to admission, non-smoker, no history of prior stroke, good pre-stroke functional status and severe initial neurological defi cit were independently associated with the decision of r-tPA use in the elderly stroke patients predictors for r-tPA treatment. Conclusion: In very elderly patients, mild neurological defi cit on arrival and rapid clinical improvement in neurological symptoms were the main reasons for exclusion from thrombolytic therapy. (Korean J Stroke 2011;13:79-84)

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