Factors influencing nonadministration of thrombolytic therapy in early arrival strokes in a university hospital in Hyderabad, India
Background: It is a well-known fact that very few patients of stroke arrive at the hospital within the window period of thrombolysis. Even among those who do, not all receive thrombolytic therapy. Objective: The objectives of this study were to determine the proportion of early arrival ischemic stro...
| Main Authors: | , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Wolters Kluwer Medknow Publications
2016-01-01
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| Series: | Annals of Indian Academy of Neurology |
| Subjects: | |
| Online Access: | http://www.annalsofian.org/article.asp?issn=0972-2327;year=2016;volume=19;issue=3;spage=351;epage=355;aulast=Pidaparthi |
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| author | Lalitha Pidaparthi Anitha Kotha Venkat Reddy Aleti Abhijeet Kumar Kohat Mridula R Kandadai Suryaprabha Turaga Jabeen A Shaik Suvarna Alladi Meena A Kanikannan Borgohain Rupam Subhash Kaul |
| author_facet | Lalitha Pidaparthi Anitha Kotha Venkat Reddy Aleti Abhijeet Kumar Kohat Mridula R Kandadai Suryaprabha Turaga Jabeen A Shaik Suvarna Alladi Meena A Kanikannan Borgohain Rupam Subhash Kaul |
| author_sort | Lalitha Pidaparthi |
| collection | DOAJ |
| description | Background: It is a well-known fact that very few patients of stroke arrive at the hospital within the window period of thrombolysis. Even among those who do, not all receive thrombolytic therapy. Objective: The objectives of this study were to determine the proportion of early arrival ischemic strokes (within 6 h of stroke onset) in our hospital and to evaluate the causes of nonadministration of intravenous and/or intraarterial thrombolysis in them. Materials and Methods: Data of all early arrival acute stroke patients between January 2010 and January 2015 were included. Factors determining nonadministration of intravenous and/or intraarterial thrombolysis in early arrival strokes were analyzed. Results: Out of 2,593 stroke patients, only 145 (5.6%) patients presented within 6 h of stroke onset and among them 118 (81.4%) patients had ischemic stroke and 27 (18.6%) patients had hemorrhagic stroke. A total of 89/118 (75.4%) patients were thrombolyzed. The reasons for nonadministration of thrombolysis in the remaining 29 patients were analyzed, which included unavoidable factors in 8/29 patients [massive infarct (N = 4), hemorrhagic infarct (N = 1), gastrointestinal bleed (N = 1), oral anticoagulant usage with prolonged international normalized ratio (INR) (N = 1), and recent cataract surgery (N = 1)]. Avoidable factors were found for 21/29 patients, include nonaffordability (N = 7), fear of bleed (N = 4), rapidly improving symptoms (N = 4), mild stroke (N = 2), delayed neurologist referral within the hospital (N = 2), and logistic difficulty in organizing endovascular treatment (N = 2). Conclusion: One-fourth of early ischemic stroke patients in our study were not thrombolyzed even though they arrived within the window period. The majority of the reasons for nonadministration of thrombolysis were potentially preventable, such as nonaffordability, intrahospital delay, and nonavailability of newer endovascular interventions. |
| first_indexed | 2024-12-13T16:39:16Z |
| format | Article |
| id | doaj.art-4a95a91f5195496abdeba5ea05579d9a |
| institution | Directory Open Access Journal |
| issn | 0972-2327 1998-3549 |
| language | English |
| last_indexed | 2024-12-13T16:39:16Z |
| publishDate | 2016-01-01 |
| publisher | Wolters Kluwer Medknow Publications |
| record_format | Article |
| series | Annals of Indian Academy of Neurology |
| spelling | doaj.art-4a95a91f5195496abdeba5ea05579d9a2022-12-21T23:38:19ZengWolters Kluwer Medknow PublicationsAnnals of Indian Academy of Neurology0972-23271998-35492016-01-0119335135510.4103/0972-2327.179976Factors influencing nonadministration of thrombolytic therapy in early arrival strokes in a university hospital in Hyderabad, IndiaLalitha PidaparthiAnitha KothaVenkat Reddy AletiAbhijeet Kumar KohatMridula R KandadaiSuryaprabha TuragaJabeen A ShaikSuvarna AlladiMeena A KanikannanBorgohain RupamSubhash KaulBackground: It is a well-known fact that very few patients of stroke arrive at the hospital within the window period of thrombolysis. Even among those who do, not all receive thrombolytic therapy. Objective: The objectives of this study were to determine the proportion of early arrival ischemic strokes (within 6 h of stroke onset) in our hospital and to evaluate the causes of nonadministration of intravenous and/or intraarterial thrombolysis in them. Materials and Methods: Data of all early arrival acute stroke patients between January 2010 and January 2015 were included. Factors determining nonadministration of intravenous and/or intraarterial thrombolysis in early arrival strokes were analyzed. Results: Out of 2,593 stroke patients, only 145 (5.6%) patients presented within 6 h of stroke onset and among them 118 (81.4%) patients had ischemic stroke and 27 (18.6%) patients had hemorrhagic stroke. A total of 89/118 (75.4%) patients were thrombolyzed. The reasons for nonadministration of thrombolysis in the remaining 29 patients were analyzed, which included unavoidable factors in 8/29 patients [massive infarct (N = 4), hemorrhagic infarct (N = 1), gastrointestinal bleed (N = 1), oral anticoagulant usage with prolonged international normalized ratio (INR) (N = 1), and recent cataract surgery (N = 1)]. Avoidable factors were found for 21/29 patients, include nonaffordability (N = 7), fear of bleed (N = 4), rapidly improving symptoms (N = 4), mild stroke (N = 2), delayed neurologist referral within the hospital (N = 2), and logistic difficulty in organizing endovascular treatment (N = 2). Conclusion: One-fourth of early ischemic stroke patients in our study were not thrombolyzed even though they arrived within the window period. The majority of the reasons for nonadministration of thrombolysis were potentially preventable, such as nonaffordability, intrahospital delay, and nonavailability of newer endovascular interventions.http://www.annalsofian.org/article.asp?issn=0972-2327;year=2016;volume=19;issue=3;spage=351;epage=355;aulast=PidaparthiAvoidable factorsrecombinant tissue plasminogen activator (rt-PA)strokethrombolysisunavoidable factors |
| spellingShingle | Lalitha Pidaparthi Anitha Kotha Venkat Reddy Aleti Abhijeet Kumar Kohat Mridula R Kandadai Suryaprabha Turaga Jabeen A Shaik Suvarna Alladi Meena A Kanikannan Borgohain Rupam Subhash Kaul Factors influencing nonadministration of thrombolytic therapy in early arrival strokes in a university hospital in Hyderabad, India Annals of Indian Academy of Neurology Avoidable factors recombinant tissue plasminogen activator (rt-PA) stroke thrombolysis unavoidable factors |
| title | Factors influencing nonadministration of thrombolytic therapy in early arrival strokes in a university hospital in Hyderabad, India |
| title_full | Factors influencing nonadministration of thrombolytic therapy in early arrival strokes in a university hospital in Hyderabad, India |
| title_fullStr | Factors influencing nonadministration of thrombolytic therapy in early arrival strokes in a university hospital in Hyderabad, India |
| title_full_unstemmed | Factors influencing nonadministration of thrombolytic therapy in early arrival strokes in a university hospital in Hyderabad, India |
| title_short | Factors influencing nonadministration of thrombolytic therapy in early arrival strokes in a university hospital in Hyderabad, India |
| title_sort | factors influencing nonadministration of thrombolytic therapy in early arrival strokes in a university hospital in hyderabad india |
| topic | Avoidable factors recombinant tissue plasminogen activator (rt-PA) stroke thrombolysis unavoidable factors |
| url | http://www.annalsofian.org/article.asp?issn=0972-2327;year=2016;volume=19;issue=3;spage=351;epage=355;aulast=Pidaparthi |
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