Intravenous Thrombolysis is Effective in Young Adults: Results from the Baden-Wuerttemberg Stroke Registry

Björn Reuter; Christoph Gumbinger; Tamara Sauer; Horst Wiethölter; Ingo Bruder; Curt Diehm; Peter A Ringleb; Rolf Kern; Werner Hacke; Michael G Hennerici; Stroke Working Group of Baden-Wuerttemberg

doi:10.3389/fneur.2015.00229

Intravenous Thrombolysis is Effective in Young Adults: Results from the Baden-Wuerttemberg Stroke Registry

Front Neurol. 2015 Nov 4:6:229. doi: 10.3389/fneur.2015.00229. eCollection 2015.

Affiliations

¹ Department of Neurology and Neurophysiology, University Hospital Freiburg , Freiburg , Germany ; Department of Neurology, Universitätsmedizin Mannheim, Heidelberg University , Mannheim , Germany.
² Department of Neurology, University Hospital Heidelberg , Heidelberg , Germany.
³ Department of Neurology, Universitätsmedizin Mannheim, Heidelberg University , Mannheim , Germany.
⁴ Formerly affiliated with Department of Neurology, Bürgerhospital Stuttgart , Stuttgart , Germany.
⁵ Office for Quality Assurance in Hospitals (GeQiK), Baden-Wuerttembergische Hospital Association , Stuttgart , Germany.
⁶ Department of Internal/Vascular Medicine, Max-Grundig-Klinik , Bühl , Germany.
⁷ Department of Neurology, Klinikum Kempten , Kempten , Germany.

Abstract

Background: The efficacy of intravenous thrombolysis (IVT) is sufficiently proven in ischemic stroke patients of middle and older age by means of randomized controlled trials and large observational studies. However, data in young stroke patients ≤50 years are still scarce. In this study, we aimed to evaluate the effectiveness and safety of IVT in young adults aged 18-50 years. Data from a consecutive and prospective stroke registry was analyzed that covers a federal state with 10.8 million inhabitants in southwest Germany.

Methods: Our analysis comprises 51,735 ischemic stroke patients aged 18-80 years and hospitalized from January 2008 to December 2012. Of these, 4,140 (8%) were aged 18-50 years and 7,529 (15%) underwent IVT. Data on 8,439 patients (16% of the study population) were missing for National Institutes of Health stroke severity score at admission and/or modified Rankin Scale (mRS) at discharge and were excluded from outcome analysis. In sensitivity analysis, patients with incomplete data were also examined. Binary logistic regression models were used adjusted for patient, hospital, and procedural parameters and stratified by age group (18-50 and 51-80 years, subgroup analyses 18-30, 31-40, and 41-50 years) to assess the relationship between IVT and mRS at discharge.

Results: IVT appears equally effective in young adults 18-50 years (adjusted odds ratio 1.40, 95% confidence interval 1.12-1.75; p = 0.003), compared to patients 51-80 years of age (1.33, 1.23-1.43; p < 0.001). Age-stratified analyses suggest an inverse relation of age and effectiveness, which appears to be highest in very young patients 18-30 years of age (2.78, 1.10-7.05; p = 0.03).

Discussion: Ischemic stroke etiology, vascular dynamics, and recovery in young patients differ from those of middle and older age. The evidence from routine hospital care in Germany indicates that IVT in young stroke patients appears to be at least equally effective as in the elderly.

Keywords: IV thrombolysis; acute stroke; age; epidemiology of stroke; stroke unit concept; young adults.