Intravenous Thrombolysis in Young Stroke Patients: Results from the SITS-ISTR

Stroke in younger patients (18–50 years) can have important long-term outcomes. Aggressive treatment of this condition is important given the longer expected survival of this population when compared to those over 50 years of age. Conflicting data exist about the relative benefit of acute treatment with intravenous alteplase in younger patients, though all prior studies have been limited by small sample size. This study sought to evaluate the safety and efficacy of this medication in younger patients when compared to older patients. A post hoc analysis of data from the Safe Implementation of Thrombolysis in Stroke – International Stroke Thrombolysis Register (SITS-ISTR) was performed on data of patients aged 18–80 years that received intravenous alteplase within 4.5 h of stroke onset between 2002 and 2010. Primary outcomes were symptomatic intracerebral hemorrhage (SICH), mortality, and functional independence at 3 months. The SITS-ISTR contained data on 3246 patients aged 18–50 years and 24,425 patients aged 51–80 years. Multivariable logistic regression models were performed for each outcome variable. Regressions were also performed for subdivision of patients in deciles (under 30 years, 31–40 years, 41–50 years, and over 50 years). There was a significant difference in the baseline characteristics of the two groups, with increasing rates of comorbidities such as hypertension, diabetes mellitus, hyperlipidemia, and atrial fibrillation, among others. The authors found that SICH occurred in 0.6% of younger patients and 1.9% of older patients (adjusted odds ratio [OR] 0.53, p = 0.02). Three-month mortality was 4.9% and 14.4% in young vs. old patients (adjusted OR 0.49, p < 0.001). Functional independence was 72.1% vs. 54.5% for young vs. old patients (adjusted OR 1.61, p < 0.0001). Evaluation of the age deciles showed progressive rates of SICH, mortality, and lower functional independence with increasing age, with steepest change of rates after age 50 years. The authors concluded that treatment with intravenous alteplase is safe in young patients, with greater benefit than in older cohorts.