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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  ;  김여진  ;  오미선  ;  유경호  ;  이병철  ;  이주헌  ;  권지현  ;  권순억  ;  허성혁  ;  최재철  ;  권형민  ;  박종무  ;  김응규  ;  나정호  ;  박희권  ;  배희준  ;  한문구  ;  홍근식  ;  조용진  ;  박만석  ;  조기현  ;  김한영  ;  이 준  ;  김동억  ;  이수주  ;  이경복  ;  박태환  ;  차명진  ;  허지회  ;  남효석  ;  차재관  ;  김철호  ;  윤병우 
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
Keywords
Stroke ; Thrombolysis ; Tissue plasminogen activation ; Elderly ; Exclusion
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.
Files in This Item:
T201104344.pdf Download
DOI
10.5853/kjs.2011.13.2.79
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Neurology (신경과학교실) > 1. Journal Papers
Yonsei Authors
Nam, Hyo Suk(남효석) ORCID logo https://orcid.org/0000-0002-4415-3995
Cha, Myoung Jin(차명진)
Heo, Ji Hoe(허지회) ORCID logo https://orcid.org/0000-0001-9898-3321
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/94714
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