Abstract
Background/Objectives This meta-analysis set out to compare the incidence of post thrombolysis symptomatic intracranial haemorrhage (sICH) between those younger and older than 80 years.
Methods A systematic literature search of Medline (Ovid), Embase (Ovid) and Web of Science (All databases) was undertaken. Publications were selected that included reported rates of sICH post thrombolysis for stroke comparing those older and younger than 80 years. The quality of the papers was assessed with the Newcastle Ottawa Quality Assessment. Subgroup analysis was undertaken dividing the cohort into various reported landmark trial definitions of sICH. Analysis was completed with Revman Web. Data was pooled using a random effects model. Odds ratios were calculated. Forest plots were generated.
Results 26 publications matched inclusion criteria; all were retrospective cohort studies. All studies were rated as good quality. There were 709/20109 (2.4%) reported sICH in the younger group. There were 223/5472 (4.1%) reported sICH in the older group. There was an increased rate of sICH in those older than 80, OR 1.45, [95% CI 1.23, 1.72], p < 0.0001, I2=0%. All subgroup analysis showed an increased rate of sICH in the older age group except by those papers reporting ECASSIII definition whose p value did not reach significance.
Conclusion The data supports the conclusion of a slightly increased rate of sICH in those older than 80 years of age. The administration of thrombolysis for stroke remains a complex shared decision among patients and neurologists requiring careful weighing of risk and benefit.
