Prevention and Treatment of Acute Stroke in the Nonagenarians and Beyond: Medical and Ethical Issues

Tiberiu A Pana, Jesus A Perdomo-Lampignano, Phyo K Myint (Corresponding Author)

Research output: Contribution to journalArticle

Abstract

Purpose of review
As one of the fastest growing portions of the population, nonagenarians will constitute a significant percentage of the stroke patient population in the near future. Nonagenarians are nevertheless not specifically targeted by most clinical guidelines. In this review, we aimed to summarise the available evidence guiding stroke prevention and treatment in this age group.

Recent findings
Several recent observational studies have shown that the benefits of anticoagulation for the oldest old patients with atrial fibrillation may outweigh the bleeding risk. A sub-analysis of the IST-3 trial has shown for the first time that thrombolysis treatment in acute ischaemic stroke may be beneficial and safe even in octogenarian patients and older. Several recent observational studies have assessed thrombolysis in nonagenarians. The latest of these has shown better disability outcomes without increased rates of symptomatic intracerebral haemorrhage with thrombolysis.

Summary
Nonagenarian stroke patients may benefit from similar preventative and therapeutic strategies as their younger counterparts. A few important exceptions include primary prevention using aspirin or statins. Patient selection is nevertheless essential given the increased adverse event rates. Patient preference should play a key role in the decision-making process. Clinical trials including more nonagenarian patients are required to yield more robust evidence.
Original languageEnglish
Article number27
Number of pages18
JournalCurrent Treatment Options in Neurology
Volume21
Issue number6
Early online date8 May 2019
DOIs
Publication statusPublished - 1 Jun 2019

Keywords

  • stroke
  • cerebrovascular disease
  • Nonagenarian
  • oldest old
  • prevention
  • management
  • Prevention
  • Stroke
  • Oldest old
  • Management
  • Cerebrovascular disease
  • LEFT ATRIAL APPENDAGE
  • TISSUE-PLASMINOGEN ACTIVATOR
  • CAROTID-ENDARTERECTOMY
  • INDIVIDUAL PATIENT DATA
  • HEALTH-CARE PROFESSIONALS
  • ACUTE ISCHEMIC-STROKE
  • DIRECT ORAL ANTICOAGULANTS
  • CHRONIC KIDNEY-DISEASE
  • ELDERLY-PATIENTS
  • 80 YEARS OLD

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