AUTHOR=Fustinoni Osvaldo 

TITLE=The Case for an Elderly Targeted Stroke Management

JOURNAL=Frontiers in Neurology

VOLUME=volume 2 - 2011

YEAR=2011

URL=https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2011.00089

DOI=10.3389/fneur.2011.00089

ISSN=1664-2295

ABSTRACT=The elderly, in whom atrial fibrillation is most prevalent, carry the greatest risk, undergoing more recurrent, deadlier strokes, with bigger deficits, slower recoveries, and more comorbidities. Age-related cerebral changes might undermine the benefit of established stroke treatments. Nevertheless, the elderly should probably also undergo thrombolysis for ischemic stroke: they do not bleed more, and die not because of hemorrhage but of concomitant illnesses. Beyond natural bleeding risks, atrial fibrillation in advanced age has a high embolic potential if not anticoagulated. Standard or lower intensity warfarin anticoagulation prevents embolic stroke in the elderly with a hemorrhage risk even lower than aspirin. Excess anticoagulation hazards are prevented with lower starting doses, stricter corrections, more frequent INR monitoring. Direct thrombin inhibitors have recently shown a benefit similar to warfarin with fewer hemorrhages. Antihypertensives probably help 80-plus stroke patients as well, but the risk/benefit of lowering blood pressure in secondary stroke prevention at that age is uncertain. In summary, emerging data suggest that stroke management should be specifically targeted to the elderly.