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Can anti-clotting drugs benefit an elderly person who has had a stroke?

Audrey K. Chun, MD
Geriatric Medicine

Thrombolysis (giving anti-clotting drugs within three hours of an acute stroke) is used hesitantly in the oldest old because they are more susceptible to bleeding. However, a study published online in "BMJ" suggests they may benefit from these meds. For the study, patients were divided into two groups: those who received thrombolysis after a stroke and those who didn't. Functional outcomes (the ability to carry out usual daily activities) at 90 days were measured, and patients who underwent thrombolysis had significantly better outcomes than untreated patients, irrespective of age. Although increasing age was associated with poorer outcomes, the researchers found significant benefits of thrombolysis in patients ages 40 to 90.

Patients over age 80 derived similar benefits from treatment as younger patients. Symptomatic bleeding into the brain was slightly higher in those over age 80. The researchers conclude that age alone shouldn't be a barrier to treatment; however, the trial wasn't randomized, and those who received thrombolysis were healthier and more functional. For these reasons, it's unclear which stroke victims age 80 and older will benefit.

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