Characteristics, temporal trends, and outcomes of intravenous thrombolysis in stroke patients aged > 80 years in China

Background/Purpose: No large cohort study has examined intravenous thrombolysis (IVT) in Chinese patients aged > 80 years.We aim to evaluate temporal trends in alteplase use, clinical characteristics, and outcomes in acute ischemic stroke (AIS) patients over 80 years of age in China. Methods: Data were collected from The China Stroke Center Alliance program, which is a nationwide, multicenter, prospective registry at 1751 hospitals in 31 provinces, between January 1, 2018, and December 14, 2022.The primary outcome was a modified Rankin scale score (mRS) of 0-2 at discharge, and the secondary study outcomes were an mRS score 0-1 and independent ambulation at discharge. The safety outcomes included in-hospital mortality and symptomatic intracranial hemorrhage(sICH). Results: Of 212,814 patients eligible for thrombolysis, 30,902 patients were aged > 80 years; among them, 8,673 patients (median [IQR] age, 84 [82-87] years) were treated with alteplase, 52.7% of whom were female (n=4570). The usage rate of alteplase in elderly patients increased from 22.1% in 2018 to 35.7% in 2022, while the rate among younger patients increased from 30.5% in 2018 to 43.3% in 2022. Patients treated with alteplase had better short-term functional outcomes, including mRS scores 0-2 (adjusted OR [aOR] 1.13, 95% CI 1.08-1.19, p<0.001), mRS scores 0-1 (aOR 1.14, 95% CI 1.09-1.20, p<0.001), and independent ambulation at discharge (aOR 1.27, 95% CI 1.19-1.39, p<0.001). Furthermore, there was no increased risk of in-hospital mortality (aOR 0.92, 95% CI 0.79-1.08, p=0.31). However, alteplase was associated with a higher risk of sICH (aOR 2.85, 95% CI 2.48-3.27, p<0.001). Conclusions: Elderly patients receiving IVT with alteplase had better short-term functional outcomes without an increased risk of in-hospital mortality; however, elderly patients are at higher risk of developing symptomatic intracranial hemorrhage. ### Competing Interest Statement The authors have declared no competing interest. ### Clinical Trial NA ### Funding Statement This study was supported by grants 2022YFC2504902 and 2022YFC2504904 from the Ministry of Science and Technology of the People?s Republic of China, grant Z200016 from the Beijing Natural Science Foundation, grant 2018000021223ZK03 from Beijing Talents Project, and grants Z201100005620010 and Z211100002921064 from the Beijing Municipal Committee of Science and Technology. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Not Applicable The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Ethical approval was obtained from the ethical review board of Beijing Tiantan Hospital (ethical approval number: KY2018-061-02) I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Not Applicable I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Not Applicable I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Not Applicable After publication of the completed study, data are available upon reasonable request, which will be considered by the corresponding authors based on the information provided by the requester regarding the study and analysis plan.