United States trends in thrombolysis for older adults with acute ischemic stroke

Clin Neurol Neurosurg. 2015 Dec:139:16-23. doi: 10.1016/j.clineuro.2015.08.031. Epub 2015 Sep 10.


Objective: Thrombolysis for ischemic stroke has been increasing in the United States. We sought to investigate recent trends in thrombolysis use in older adults.

Methods: A retrospective, observational analysis of hospitalization data from the Nationwide Inpatient Sample (NIS) in 2005-2010 was performed. Older adults (≥65 years) admitted with a primary diagnosis of acute ischemic stroke were included. Trends in the population-based rates of thrombolysis and outcomes from the NIS were evaluated using the Cochran-Armitage test.

Results: Thrombolysis in older adult stroke patients increased from 1.7% to 5.4% (2005-2010; trend P<0.001). Large increases were observed among urban patients, urban hospitals, and high volume facilities. Individuals ≥85 years were less likely to receive thrombolysis than younger ages throughout the study period, although there was an increase from an odds ratio of 0.50 (95% CI: 0.44-0.57) to 0.75 (95% CI: 0.69-0.81) from 2005-2006 to 2009-2010 when compared to 65-74 year olds. For those receiving thrombolysis, no change was observed in intracerebral hemorrhage over time. In-hospital mortality rates did not change significantly over the study period for age subgroups and length of stay declined from 2005 to 2010 for the thrombolysis group (7.6 vs 7.0 days; trend P<0.001).

Conclusions: Rates of thrombolysis in older adults progressively increased, especially in the oldest old. Increases were largely driven by urban and high volume hospitals.

Keywords: Epidemiology; Ischemic stroke; Thrombolysis; Tissue plasminogen activator; tPA.

Publication types

  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Brain Ischemia / complications
  • Brain Ischemia / drug therapy*
  • Brain Ischemia / mortality
  • Cerebral Hemorrhage / epidemiology
  • Cerebral Hemorrhage / mortality
  • Databases, Factual
  • Female
  • Fibrinolytic Agents / therapeutic use*
  • Hospital Mortality
  • Hospitals / statistics & numerical data
  • Humans
  • Male
  • Odds Ratio
  • Retrospective Studies
  • Stroke / drug therapy*
  • Stroke / etiology
  • Stroke / mortality
  • Thrombolytic Therapy / trends*
  • Tissue Plasminogen Activator / therapeutic use*
  • Treatment Outcome
  • United States / epidemiology


  • Fibrinolytic Agents
  • Tissue Plasminogen Activator