ArticleBMJ (Clinical research ed.)2010
Thrombolysis in very elderly people: controlled comparison of SITS International Stroke Thrombolysis Registry and Virtual International Stroke Trials Archive.
Article in BMJ (Clinical research ed.), 2010. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 68 papers, 5 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
68 citing papers in PubMed, 5 syntheses or guidelines pooled it.
- Alteplase for Acute Ischemic Stroke in Patients Aged >80 Years: Pooled Analyses of Individual Patient Data.Stroke · 2020Pooled it
- The Chinese Stroke Association scientific statement: intravenous thrombolysis in acute ischaemic stroke.Stroke and vascular neurology · 2017Guideline
- Effect of treatment delay, age, and stroke severity on the effects of intravenous thrombolysis with alteplase for acute ischaemic stroke: a meta-analysis of individual patient data from randomised trials.Lancet (London, England) · 2014Pooled it
- Details of a prospective protocol for a collaborative meta-analysis of individual participant data from all randomized trials of intravenous rt-PA vs. control: statistical analysis plan for the Stroke Thrombolysis Trialists' Collaborative meta-analysis.International journal of stroke : official journal of the International Stroke Society · 2013Guideline
- Recombinant tissue plasminogen activator for acute ischaemic stroke: an updated systematic review and meta-analysis.Lancet (London, England) · 2012Pooled it
- Tenecteplase versus alteplase for acute ischaemic stroke in the elderly patients: a post hoc analysis of the TRACE-2 trial.Stroke and vascular neurology · 2025Trial
- Association of Thrombectomy With Stroke Outcomes Among Patient Subgroups: Secondary Analyses of the DEFUSE 3 Randomized Clinical Trial.JAMA neurology · 2019Trial
- Stroke Prognostication using Age and NIH Stroke Scale: SPAN-100.Neurology · 2013Trial
- Experience with Tenecteplase in Treatment of Acute Ischaemic Stroke in Window: Analysis and Outcomes at a Tertiary Care Institute in Central India.Annals of neurosciences · 2026Article
- Characteristics, temporal trends and outcomes of intravenous thrombolysis in Chinese patients aged>80 years who had a stroke.Stroke and vascular neurology · 2025Observational
- [Management of acute ischemic stroke : Bridging vs. mothership].Radiologie (Heidelberg, Germany) · 2025Review
- Observational
- Risk prediction model for poor prognosis after intravenous thrombolysis among ischemic stroke patients aged ≥ 80 years and analysis of follow-up.Scientific reports · 2025Article
- Multivariable Prediction Model for Futile Recanalization Therapies in Patients With Acute Ischemic Stroke.Neurology · 2022Article
- Adverse consequences of immediate thrombolysis-related complications: a multi-centre registry-based cohort study of acute stroke.Journal of thrombosis and thrombolysis · 2022Article
- The difference in red blood cell distribution width from before to after thrombolysis as a prognostic factor in acute ischemic stroke patients: A 2-year follow-up.Frontiers in neurology · 2022Article
- Article
- Experiences With Intravenous Thrombolysis in Acute Ischemic Stroke by Elderly Patients-A "Real World Scenario".Frontiers in neurology · 2021Article
- Human neural stem cells improve early stage stroke outcome in delayed tissue plasminogen activator-treated aged stroke brains.Experimental neurology · 2020Article
- [Acute stroke treatment in old age].Medizinische Klinik, Intensivmedizin und Notfallmedizin · 2020Review
8 more citing papers are in PubMed but not listed here.
Corrections and comments
- Commented on by
- Commented on by
- Commented on by[Not Available].2011
- Commented on by
Authors and funding
10 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveTo assess effect of age on response to alteplase in acute ischaemic stroke.
designAdjusted controlled comparison of outcomes between non-randomised patients who did or did not undergo thrombolysis. Analysis used Cochran-Mantel-Haenszel test and proportional odds logistic regression analysis.
settingCollaboration between International Stroke Thrombolysis Registry (SITS-ISTR) and Virtual International Stroke Trials Archive (VISTA).
participants23 334 patients from SITS-ISTR (December 2002 to November 2009) who underwent thrombolysis and 6166 from VISTA neuroprotection trials (1998-2007) who did not undergo thrombolysis (as controls). Of the 29 500 patients (3472 aged >80 ("elderly," mean 84.6), data on 272 patients were missing for baseline National Institutes of Health stroke severity score, leaving 29 228 patients for analysis adjusted for age and baseline severity.
main outcome measuresFunctional outcomes at 90 days measured by score on modified Rankin scale.
resultsMedian severity at baseline was the same for patients who underwent thrombolysis and controls (median baseline stroke scale score: 12 for each group, P=0.14; n=29 228). The distribution of scores on the modified Rankin scale was better among all thrombolysis patients than controls (odds ratio 1.6, 95% confidence interval 1.5 to 1.7; Cochran-Mantel-Haenszel P<0.001). The association occurred independently among patients aged ≤80 (1.6, 1.5 to 1.7; P<0.001; n=25 789) and in those aged >80 (1.4, 1.3 to 1.6; P<0.001; n=3439). Odds ratios were consistent across all 10 year age ranges above 30, and benefit was significant from age 41 to 90; dichotomised outcomes (score on modified Rankin scale 0-1 v 2-6; 0-2 v 3-6; and 6 (death) v rest) were consistent with the results of the ordinal analysis.
conclusionsOutcome in patients with acute ischaemic stroke is significantly better in those who undergo thrombolysis compared with those who do not. Increasing age is associated with poorer outcome but the association between thrombolysis treatment and improved outcome is maintained in very elderly people. Age alone should not be a barrier to treatment.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.