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Incidence of acute stroke in older people is continuously growing. However, treatment with intravenous tissue plasminogen activator (tPA) in this group of patients is still scarce.1 The majority of clinical trials using thrombolytic treatment have excluded very older people, and although the last European Stroke Organization (ESO) Guidelines support intravenous tPA treatment without age-limit (class III, level C), the terms of tPA-labelled indications do not include patients ≥80 years.2 The study by Mishra and colleagues aimed to evaluate the safety and efficacy of intravenous tPA according to age, especially in very older people, controlled by patients with similar stroke severity without tPA treatment.
This is a large retrospective comparison of two different registers of stroke treatments. A total 23 334 tPA-patients were selected from the SITS–ISTR (Safe Implementation of Treatment in Stroke–International Stroke Thrombolysis Registry) prospective database. They were compared with 6166 patients suffering from stroke who did not receive tPA, obtained from VISTA (Virtual International Stroke Trials Archive). VISTA is a registry of patients included in …
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