Outcomes of Intravenous Tissue Plasminogen Activator in Nonagenarians with Acute Ischemic Stroke (P4.281)

OBJECTIVE: To evaluate effects of intravenous (IV) tissue plasminogen activator (tPA) on aged 90 years or older acute ischemic stroke (AIS) patients. BACKGROUND: People aged 90 years or old are the fast growing group in the Northern American. But they are excluded from traditional clinical trials. IV tPA is the most beneficial emergent therapy for AIS. We retrospectively reviewed the administration of IV tPA for AIS patients who were 90 years or older from June 2011 to Oct 2014 in our institution. DESIGN/METHODS: We reviewed the clinical characteristics of AIS patients who are 90 years or older after IV tPA treatment at presentation, complications, and outcomes. Outcome measures at discharge were improvement of NIHSS, mRS, symptomatic intracranial hemorrhage (sICH), and discharge deposition. RESULTS: Twenty patients (female 80[percnt]; median age 93 years; range 90-101 years) had IV tPA treatment within 3 hrs after the onset of AIS after the consent was obtained from the family or patients. Thirteen patients (65[percnt]) had history of atrial fibrillation without anticoagulation. Baseline, nearly half of patients (9 /20) needed assistance for ambulation from gait instability, but they were otherwise functional. Rest were independent or with minimal assistance (mRS ≤ 3). Admission mean NIHSS was 15 (ranging: 1-34). Four patients (20[percnt]) had hemorrhage, but none had sICH. Discharge mean NIHSS 13. Four patients (20[percnt]) had favorable outcome (mRS ≤ 3). Two patients were discharged to home. Twelve patients went to nursing home, seven of which were from nursing home. Seven patients died from cardiopulomonary failure or were hospice. CONCLUSIONS: No adverse effect of IV tPA on nonagenarian AIS patients although the benefits were less compared to younger patients. Patients who had low mRS and admission NIHSS had more favorable outcome. Thus, IV tPA should be considered in selected nonagenarian AIS patients with favorable baseline function. Disclosure: Dr. Chaubal has nothing to disclose. Dr. Wise has nothing to disclose. Dr. Moore has nothing to disclose. Dr. Jerde has nothing to disclose. Dr. Laura has nothing to disclose. Dr. Remmel has nothing to disclose. Dr. Liu has nothing to disclose.