The efficacy and safety of intravenous thrombolysis in elderly patients with mild ischemic stroke

Objective To evaluate the efficacy and safety of intravenous thrombolysis with recombinant tissue-plasminogen activator (rt-PA) in elderly patients with early-stage mild ischemic stroke (IS). Methods This was a prospective, open-label, controlled study.Ninety-four elderly patients with mild IS admitted to our hospital from January 2014 to December 2017 were randomized into a thrombolysis arm (TA, n=46) and a control arm (CA, n=48). The short-term endpoints were the National Institutes of Health stroke scale (NIHSS) scores on 3rd, 7th, 14thday after admission and the secondary endpoints were the modified Rankin Scale (mRS) score and the morbidity of recurrence IS within 90 days.Safety was evaluated by the incidence of intracranial hemorrhage (IH) and early neurological deterioration (END) during hospitalization. Results The baseline NIHSS scores of patients in the TA and CA groups were similar [(4.1±0.7) vs.(4.1±0.7)]. However, there were significant differences in the NIHSS score on 3rd [(3.4±1.2) vs.(4.2±1.4)], 7th[(3.0±1.8) vs.(4.1±1.6)] and 14thday [(2.5±2.0) vs.(3.4±1.6)], respectively, between the TA group and the CA group.Furthermore, the TA group was associated with a significantly higher proportion of patients with good prognosis (mRS, 0-2), compared with the CA group (71.7% vs.35.4%, P 3 could benefit from thrombolytic therapy.There were 1 case of symptomatic IH and 1 case of progressive stroke in the TA group, and 1 case of IH and 2 cases of progressive stroke in the control group.There were no significant differences in the rate of either END or IH between the two groups (P>0.05). Two patients in the TA group and three patients in the control group had recurrent IS within 90 days and the recurrence rate of IS was also similar within 90 days (P>0.05). Conclusions Intravenous thrombolytic therapy with rt-PA can improve the prognosis of elderly patients with mild stroke without increased risk of END, IH, or recurrence of IS. Key words: Stroke; Brain Ischemia; Thrombolytic therapy