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80세 이상 급성기 허혈뇌졸중 환자에서 정맥내 혈전 용해 치료를 결정하는데 연관된 요인

Other Titles
 The Factors Associated with the Decision of r-tPA Use in Acute Ischemic Stroke Patients Aged 80 Years or Older 
Authors
 정민경  ;  김예림  ;  윤병우  ;  김철호  ;  차재관  ;  남효석  ;  허지회  ;  차명진  ;  박태환  ;  이경복  ;  이수주  ;  김동억  ;  이 준  ;  김한영  ;  조기현  ;  박만석  ;  조용진  ;  홍근식  ;  한문구  ;  배희준  ;  박희권  ;  나정호  ;  김응규  ;  박종무  ;  권형민  ;  최재철  ;  허성혁  ;  권순억  ;  권지현  ;  이주헌  ;  이병철  ;  유경호  ;  오미선  ;  김여진 
Citation
 Korean Journal of Stroke (대한뇌졸중학회지), Vol.13(2) : 79-84, 2011 
Journal Title
 Korean Journal of Stroke  (대한뇌졸중학회지) 
ISSN
 1229-4101 
Issue Date
2011
Abstract
Background Small proportions of all the elderly stroke patients receive recombinant tissue plasminogen activator (r-tPA) therapy, although old age is not a proven contraindication to intravenous thrombolytic therapy for acute ischemic stroke. The purpose of this study was to identify reasons for exclusion from r-tPA therapy and factors associated with the decision of r-tPA use in elderly patients with acute ischemic stroke. Methods From the acute stroke registries of 22 domestic university hospitals taking the r-tPA therapy from January 2007 to May 2010, we extracted data of all acute ischemic stroke patients who were aged 80 or over and arrived within onset 3 hours. For all patients, we assessed the eligibility of r-tPA therapy using National Institute of Neurological Disorders and Stroke (NINDS) r-tPA trial criteria. For eligible patients, we compared all clinical variables between patients who were treated with r-tPA and those who were not, and analyzed potential factors related to the decision of r-tPA use. Results A total of 494 patients were included in this study. 255 patients (51.6%) were excluded by NINDS r-tPA trial criteria and the major reasons for exclusion were minor neurological deficit (53.7%) and clinical improvement (17.3%). Among 239 patients who were eligible for r-tPA, 162 (32.8%) patients received r-tPA and 77 (15.6%) did not. Multivariable analysis showed that younger age, shorter time-delay from onset to admission, non-smoker, no history of prior stroke, good pre-stroke functional status and severe initial neurological deficit were independently associated with the decision of r-tPA use in the elderly stroke patients predictors for r-tPA treatment. Conclusion In very elderly patients, mild neurological deficit on arrival and rapid clinical improvement in neurological symptoms were the main reasons for exclusion from thrombolytic therapy.
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/94714
DOI
10.5853/kjs.2011.13.2.79
Appears in Collections:
1. Journal Papers (연구논문) > 1. College of Medicine (의과대학) > Dept. of Neurology (신경과학교실)
Yonsei Authors
남효석(Nam, Hyo Suk) ; 차명진(Cha, Myoung Jin) ; 허지회(Heo, Ji Hoe)
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