Efficacy and safety of intravenous thrombolytic therapy in acute ischemic stroke: Predictors of good prognosis and outcomes of the elderly population

Objectives: This study aims to evaluate the efficacy, safety, and complications of intravenous thrombolytic therapy (IVTT), identify the prognostic factors in treated patients, and assess outcomes in patients aged over 80 years. Patients and methods: Between June 2014 and March 2020, 155 patients with acute ischemic stroke were enrolled in this retrospective observational study and assigned to the IVTT group (44 males, 37 females; median age: 69 years; IQR, 58–79 years) and the non-IVTT group (30 males, 44 females; median age: 74 years; IQR, 65–82 years). The modified Rankin scale score at the third month for all patients and hemorrhagic transformation rates in the IVTT group were recorded. Outcomes were compared between patients aged over and under 80 years within the IVTT group. Results: Good outcomes at the third month were significantly higher in the IVTT group than in the non-IVTT group (37% vs. 17.6%, p = 0.007), with symptomatic intracerebral hemorrhage occurring in 6.2% of patients within the first 36 h after IVTT; baseline National Institutes of Health Stroke Scale (NIHSS) score and age were independent predictors of favorable outcomes. Conclusion: In our study, IVTT reduced the disability at the third month and can be safely performed in carefully selected patients. In older patients or those with high NIHSS scores, alternative therapies may also be considered.