Cerebral Thrombolysis in Rural Residents Aged ≥ 80
Received 30 March 2020
Accepted for publication 5 August 2020
Published 24 September 2020 Volume 2020:15 Pages 1737—1751
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 2
Editor who approved publication: Dr Richard Walker
Piotr Sobolewski,1,2 Waldemar Brola,1,3 Jacek Wilczyński,1 Wiktor Szczuchniak,2 Tomasz Wójcik,1 Aleksandra Wach-Klink,2 Marek Kos,2,4 Grzegorz Kozera5
1Collegium Medicum, Jan Kochanowski University, Kielce, Poland; 2Department of Neurology and Stroke Unit, Holy Spirit Specialist Hospital in Sandomierz, Sandomierz, Poland; 3Department of Neurology and Stroke Unit, Saint Lukas Hospital in Końskie, Końskie, Poland; 4Department of Public Health, Medical University of Lublin, Lublin, Poland; 5Medical Simulation Center, Medical University of Gdańsk, Gdańsk, Poland
Correspondence: Piotr Sobolewski
Collegium Medicum, Jan Kochanowski University, 19 IX Wieków Kielc Str, Kielce 25-217, Poland
Tel +48 608510991
Fax +48 158330593
Purpose: The proportion of older people in Poland is higher in rural areas than in urban areas. Thus, we aimed to evaluate treatment rate and factors associated with outcome and safety of intravenous thrombolysis (IVT) in rural residents aged ≥ 80 years admitted to primary stroke centers.
Patients and Methods: This study was a retrospective, observational cohort study of 873 patients treated with recombinant tissue plasminogen activator (rt-PA) in primary stroke centers between February 1, 2009 and December 31, 2017. Among them were 527 rural residents and 231 (26.5%) were ≥ 80 years of age. The analyses between rural and urban patients aged ≥ 80 and between rural patients aged < 80 and aged ≥ 80 were performed.
Results: The proportion of patients aged ≥ 80 treated with rt-PA was comparable in rural and urban residents (27.9% vs 24.3% p = 0.24). Rural patients aged ≥ 80 were also characterized by lower incidence of cardiovascular risk factors and better patients’ conditions on admission to hospital. Symptomatic intracerebral hemorrhage rate among ≥ 80-year-old stroke patients was lower in those living in rural areas than in those living in urban areas (5.4% vs 14.3%, p = 0.02); there were no differences regarding mortality and 3-month functional outcome between both populations. The older group of rural patients was characterized by a higher 3-month mortality (28.5% vs 12.6%, p < 0.001) and lower functional independence rate (34.0% vs 50.5%, p < 0.001) than rural younger patients. Antiplatelet (OR 2.43, 95% CI 1.04– 5.66, p = 0.04) and anticoagulant therapy before stroke (OR 3.64, 95% CI 1.21– 10.99, p = 0.022), early ischemic changes in baseline computerized tomograprpahy (OR 2.65, 95% CI 1.03– 6.82, p = 0.043) were associated with unfavorable outcome; and higher National Institute of Health Stroke Scale score on admission (OR 1.01, 95% CI 1.01– 1.20, p = 0.039), higher baseline count of white blood cells (OR 1.33, 95% CI 1.10– 0.62, p = 0.003) were associated with mortality in rural patients over 80.
Conclusion: We suggest that rural patients aged ≥ 80 may be safely treated with IVT in routine practice. However, lower efficacy and a higher mortality must be considered in former use of Vitamin K antagonist and antiplatelet or high white blood cells count.
Keywords: ischemic stroke, rural patients aged ≥ 80, intravenous thrombolysis, atrial fibrillation, VKA
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