- 作者：Syoichiro Kono ; Kentaro Deguchi ; Nobutoshi Morimoto ; Tomoko Kurata ; Toru Yamashita ; Yoshio Ikeda ; Hisashi Narai ; Yasuhiro Manabe ; Yoshiki Takao ; Sanami Kawada ; Kenichi Kashihara ; Yasushi Takehisa ; Satoshi Inoue ; Hideki Kiriyama ; Koji Abe
- 关键词：Acute ischemic stroke ; edaravone ; elderly ; intracerebral hemorrhage ; recanalization ; tissue plasminogen activator
- 刊名：Journal of Stroke and Cerebrovascular Diseases
- 出版年：2013
- 出版时间：October, 2013
- 年：2013
- 卷：22
- 期：7
- 页码：1175-1183
- 全文大小：106 K
Background
Alteplase, a recombinant tissue plasminogen activator (tPA), was approved for patients with acute ischemic stroke within 3 hours of stroke onset in Japan in October 2005 at a dose of 0.6 mg/kg. The aim of this study was to assess the safety and efficacy of alteplase in elderly patients in Japan.Methods
One hundred twenty-nine consecutive patients who were admitted to our 5 hospital groups and who received intravenous tPA within 3 hours of stroke onset between January 2010 and December 2011 were divided into 2 groups by age (<80 years of age [younger group] and >80 years of age [older group]) and by treatment with or without edaravone. Clinical backgrounds and outcomes were investigated.
Results
The National Institutes of Health Stroke Scale score on admission was not different in both groups, but the National Institutes of Health Stroke Scale scores 7 days after stroke onset were significantly higher in the older group (score 8; P < .05) than in the younger group (score 4), and the ratio of patients with a modified Rankin Scale score of 4 to 6 was significantly greater in the older group (41.7 % ; P < .05) than in the younger group (22.2 % ). However, there was no difference in asymptomatic and symptomatic intracerebral hemorrhage rates between the younger and older groups (asymptomatic 20.2 % v 18.8 % ; symptomatic 2.6 % v 2.1 % ). Patients with edaravone showed a higher recanalization rate (61.9 % ; P < .01) and a better modified Rankin Scale score at 3 months poststroke (P < .01) than the nonedaravone group.
Conclusions
These data suggest that intravenous alteplase (0.6 mg/kg) within 3 hours of stroke onset was safe and effective, even for very old patients (¡Ý80 years of age), but resulted in poor outcomes relating not to tPA but to aging. In addition, edaravone may be a good partner for combination therapy with tPA to enhance recanalization and reduce hemorrhagic transformation.