546 publications from this institution
Octogenarians can be selected for thrombolysis therapy after CT scan without a detrimental effect on outcome In the current issue of JNNP , Ringleb et al 1 report data on patients, either younger or older than 80 years, treated with systemic thrombolysis for an acute ischaemic stroke (see page 690) . Interestingly, the group of octogenarians were analysed with respect to the initial imaging modality (MRI or CT). The overall rate of haemorrhage and improved efficacy outcomes was not significantly different in the two age groups and no significant difference was observed for efficacy outcomes in MRI versus CT patients. Ringleb et al 1 deal …
<i>Background:</i> Intravenous (i.v.) thrombolysis with rt-PA within 3 h from symptom onset is the only approved treatment of pharmacological revascularization in acute ischemic stroke. However, little information exists on its use in elderly patients, in particular those aged >80 years, who at present are excluded from treatment. <i>Methods:</i> In a multicenter Italian study on i.v. thrombolysis, patients aged >80 years (n = 41) were compared with those aged ≤80 years (n = 207) regarding the percentage of symptomatic (nonfatal and fatal) intracerebral hemorrhage (SICH), favorable 3-month functional outcome (modified Rankin Scale score 0–2) and poor outcome (death or dependence, i.e. modified Rankin Scale score 3–5). <i>Results:</i> The percentage of SICH (nonfatal and fatal) was comparable between older (2.4%, 2.4%) and younger (2.4%, 2.4%) patient groups (p = 1.0). At 3 months, favorable outcome occurred in 44% and dependence in 22% of the older, and respectively in 58.5 and in 30.9% of the younger patients (p = 0.897). Patients aged >80 years had a higher mortality (34.1%) as compared to those aged ≤80 years (10.6%) (p < 0.001). Baseline National Institute of Health Stroke Scale score was the only statistically significant predictor of both mortality (OR = 1.26; 95% CI = 1.07–1.50) and poor outcome (OR = 1.39; 95% CI = 1.14–1.68) in the >80-year-old group. <i>Conclusions:</i> Acute ischemic stroke patients aged >80 years treated with i.v. rt-PA have a higher mortality than younger patients, but there are no differences for SICH nor for favorable outcome. Our data suggest that thrombolytic therapy should not be a priori denied for appropriately selected >80-year-old patients but randomized controlled clinical trials are necessary before definite recommendations can be given.
ters on coronary-artery revascularization focus on percutaneous coronary intervention or coronaryartery bypass grafting; they barely mention the medical reperfusion treatment of myocardial infarction.The chapters about peripheral arterial disease and stroke are well written.Surprisingly, the book does not include a chapter on the treatment of venous thromboembolism, but it does contain one chapter on the management of venous thromboembolism during pregnancy and one chapter on thromboembolic disease in children.Both chapters are written by authors with remarkable experience in these fields.In conclusion, Thrombosis in Clinical Practice is well written and includes much up-to-date information.Despite some inconsistencies and overlapping content among chapters, it focuses on issues that are not addressed in other books on the same topic.
Approximately 50-75% of patients with venous thromboembolism have a readily identifiable risk factor, either transient or permanent, whereas the remaining episodes are classified as unprovoked. The incidence of first-time venous thromboembolism rises exponentially with age. Whether the prevalence and the relative weight of major risk factors differ between elderly and younger patients is unclear. We performed a multicenter, prospective, observational study on consecutive patients with objectively confirmed acute venous thromboembolism admitted to 25 Italian hospitals. Baseline characteristics and information on temporary and permanent risk factors at the time of the index event were secured by an electronic data network. We enrolled 2119 patients (49.8% men), of whom 440 (20%) were more than 75 years of age and 1679 (79.2%) 75 years of age or less. Elderly patients were more likely to have pulmonary embolism at presentation (33.6 and 25.6%, respectively, P < 0.001). After binary logistic regression analysis, we found that the risk of venous thromboembolism in the elderly, compared with the younger age group, was significantly associated with immobilization (odds ratio: 2.46, 95% confidence interval: 1.85-3.27) and with severe medical disorders (odds ratio: 1.99, 95% confidence interval: 1.41-2.80), whereas male sex (odds ratio: 0.53, 95% confidence interval: 0.42-0.66), surgery (odds ratio: 0.61, 95% confidence interval: 0.43-0.85), and trauma (odds ratio: 0.49, 95% confidence interval: 0.31-0.77) were less common risk factors in the elderly than in younger patients. Use of thromboprophylaxis prior to the index event was not different between the two age groups. Severe medical disorders and immobilization are strongly associated with the occurrence of venous thromboembolism in the elderly. Our findings stress the need for adequate thromboprophylaxis in this setting.
Summary In a randomized double-blind crossover study in 16 patients with enhanced in vitro spontaneous platelet aggregation, sulfinpyrazone proved to be effective in normalizing platelet aggregability within 4 days after initiation of therapy.
