P. N. Sylaja, MD, Calgary Stroke Program, Department of Clinical Neurosciences, University of Calgary, Calgary, AB.
Philip A. Barber, MD, MRCP (UK), FRCPC, Calgary Stroke Program, Department of Clinical Neurosciences, University of Calgary, Calgary, AB.

The very old represent the fastest-growing segment of the population in developed and developing countries and, in view of the increased incidence of stroke with advancing age, stroke-related disability is expected to increase in the population. Although patients more than 80 years of age account for 30% of the patients with strokes, the role of intravenous thrombolysis in this age group is insufficiently defined. There are no randomized trials that focus specifically on older patients with acute ischemic stroke. Recently, several case series on the use of intravenous tissue plasminogen activator (tPA) in older adults in clinical practice have shown that the outcome of older patients after stroke is poor, but the risk of symptomatic intracerebral hemorrhage (SICH) after tPA has been variable, ranging from 4.4-13%. Current evidence suggests that, by careful selection, tPA may be safely given to older adults without increased risk of SICH within the three-hour time window. Further randomized data from trials will allow more definitive conclusions on the use of tPA in the older population.
Key words: thrombolytic therapy, acute stroke, cerebral ischemia, tissue plasminogen activator, symptomatic intracerebral hemorrhage.