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

  • Cerebrovascular Disorders (D Jamieson, Section Editor)
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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.

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  1. Ageing Clinical and Experimental Research Team, Institute of Applied Health Sciences, School of Medicine, Medical Sciences & Nutrition, University of Aberdeen, Aberdeen, UK

    Tiberiu A. Pana, Jesus A. Perdomo-Lampignano BSc & Phyo K. Myint MD

  2. School of Medicine, Medical Sciences and Nutrition, Room 4.013, Polwarth Building, Foresterhill, Aberdeen, AB25 2ZD, Scotland, UK

    Phyo K. Myint MD

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Pana, T.A., Perdomo-Lampignano, J.A. & Myint, P.K. Prevention and Treatment of Acute Stroke in the Nonagenarians and Beyond: Medical and Ethical Issues. Curr Treat Options Neurol 21, 27 (2019). https://doi.org/10.1007/s11940-019-0567-0

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