Thrombolytic therapy for ischemic stroke in patients over 80 years of age: hospital registry data

   Intravenous thrombolysis is the main method of reperfusion therapy for patients with ischemic stroke (IS) within the first 4.5 hours of symptom onset.

   Objective: to evaluate the clinical results of intravenous reperfusion therapy with a domestic thrombolytic drug, non-immunogenic staphylokinase (Fortelyzin®, SuperGene LLC, Russia), in patients with acute ischemic stroke (AIS) in the age group over 80 years in comparison with alteplase.

   Material and methods. Data from the hospital registry of patients over 80 years of age with AIS who were treated at the Penza G.A. Zakharin City Clinical Hospital No. 6 from January 2021 to April 2025 are presented. All patients underwent analysis of clinical, laboratory, and instrumental data in accordance with the procedure for providing medical care to patients with acute ischemic stroke and the reperfusion therapy protocol. The non-immunogenic staphylokinase group included 64 patients aged 80 to 94 years with AIS, and the alteplase group included 64 patients aged 80 to 96 years. The severity of neurological deficit according to the NIHSS upon admission was 13 points on average (from 5 to 23 points) in the non-immunogenic staphylokinase group and 12 points (from 5 to 23 points) in the alteplase group. No subsequent mechanical thromboembolectomy was performed. Safety criteria were the number of haemorrhagic transformations according to the Heidelberg classification and all-cause mortality at 90 days. The criterion for the effectiveness of thrombolytic therapy was the number of patients with good functional recovery (0–2 points on the modified Rankin scale – MRS) on day 90. Statistical processing of the results was performed using Microsoft Office.

   Results. In the non-immunogenic staphylokinase group, parenchymal haematoma (PH) type 1 was observed in two patients (3 %), and PH type 2 in five patients (8 %). In the alteplase group, type 1 PH was observed in two patients (3 %; p = 1.00), and type 2 PH was observed in four patients (6 %; p = 0.63). No significant differences in mortality on day 90 were found between the groups (34 % vs 47 %; p = 0.10). Good functional recovery (MRS 0–2 points) on day 90 was observed in 22 (34 %) patients in the non-immunogenic staphylokinase group and in 16 (25 %) patients in the alteplase group (p = 0.25).

   Conclusion. Thrombolytic therapy with non-immunogenic staphylokinase in elderly patients with AIS tends to have a higher probability of improving functional outcomes compared with alteplase and a comparable safety profile.

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