Background: Thrombolysis trials have recruited few patients aged ≥80, leading to risk-benefit concerns in the elderly. Leukoaraiosis (LA) has been associated with hemorrhagic transformation (HT) and increases with advanced age. We tested whether there were any independent associations between age, leukoaraiosis and HT.
Methods: Consecutive IV tPA-treated patients at the RMH Comprehensive Stroke Centre 2004-2009, with 24-48hrs post-treatment CT/MRI, were identified from a prospective database. Leukoaraiosis on baseline CT scans was rated using the modified Van Sweiten Score (VSS) by 2 independent raters. VSS measures white matter lucencies anteriorly and posteriorly in each hemisphere as absent(0), mild(1), confluent(2); (maximum score 8, severe>4). Disagreements were resolved by consensus. HT was assessed on routine 24-48hr CT/MRI using ECASS criteria - hemorrhagic infarct(HI) or parenchymal hematoma(PH) and judged symptomatic by the treating neurologist. Fisher’s exact 2-sided test was performed.
Results: There were 208 IV tPA patients (mean age 71.0yrs, range 24-92). There were 65/208 (31%) aged ≥80. Overall, HT occurred in 41/208 (19.7%), 31 HI, 10 PH (4 symptomatic). Age was not associated with HT (any HT:OR=1.03, 95%CI=0.5-2.12, p=0.99; PH: OR=0.54, 95%CI=0.13-2.3, p=0.73). There were 2 PH in 65 patients≥80 years, both asymptomatic. Leukoaraiosis was present in 113/208 (54%, severe 16%) and increased with age (p<0.001). Leukoaraiosis was not associated with PH (any LA: OR=0.83, 95%CI=0.25-2.8, p=0.99; severe LA: OR=0.56, 95%CI=0.09-3.5, p=0.99).
Conclusions: Age ≥80 or leukoaraiosis did not increase the risk of HT (including PH) after thrombolysis, although leukoaraiosis increased with age. Neither factor should exclude otherwise eligible patients from tPA treatment.