To the Editor: Thrombolysis with intravenous alteplase is
widely accepted as an effective treatment for individuals
with acute ischemic stroke,1 but few individuals aged 80
and older are treated with alteplase.2 The risk:benefit ratio
of thrombolysis might be less favorable with older age
because of a higher risk of adverse events and lower
efficacy.3,4 Outcomes in older adults treated with alteplase
has been studied mostly in comparison with younger individuals,4,5
but to reach a firm conclusion concerning the
appropriateness of treating older adults with thrombolysis,
one should also contrast treatment with no treatment. Individuals
aged 80 and older with stroke have a higher casefatality
rate, longer hospitalization, and are less likely to be
discharged home than younger individuals.6 The results of a
recent collaborative project suggest that individuals aged 80
and older derive similar benefit from treatment with intravenous
alteplase as younger individuals.7 The aim of the
present study was to assess the effectiveness of thrombolysis
in relation to age in an unselected prospective observational
cohort, in which all individuals with an ischemic stroke
admitted within 4 hours of symptom onset were registered