Barriers to Stroke Thrombolysis
Introduction: Thrombolytic therapy with intravenous recombinant tissue plasminogen activator (rt-PA) is the cornerstone of acute ischaemic stroke treatment. The number of stroke patients receiving thrombolytic therapy in India has improved over the recent years. However, Warangal despite being...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
JCDR Research and Publications Private Limited
2017-12-01
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| Series: | Journal of Clinical and Diagnostic Research |
| Subjects: | |
| Online Access: | https://jcdr.net/articles/PDF/10919/31815_021217_31815_F(AP)_(PB_BT_SU_AP)_PFA(MJ_GG)_PFA2(MJ_SS).pdf |
| Summary: | Introduction: Thrombolytic therapy with intravenous
recombinant tissue plasminogen activator (rt-PA) is the
cornerstone of acute ischaemic stroke treatment. The number
of stroke patients receiving thrombolytic therapy in India has
improved over the recent years. However, Warangal despite
being the second largest city in Telangana, witnesses stroke
thrombolysis infrequently.
Aim: To study the factors which prevent stroke thrombolysis at
a tertiary care center in Warangal.
Materials and Methods: The study was undertaken at Kakatiya
Medical College (KMC) and its associate Mahatma Gandhi
Memorial Hospital (MGMH), from October 2016 to March 2017.
The study subjects were recruited from the patients presenting
to medical emergency or neurology outpatient department
(OPD).We enrolled the consecutive ischaemic stroke patients
who presented within three days of the symptoms onset and
fulfilled the inclusion and exclusion criteria for thrombolysis as
defined by the National Institute of Neurological Disorders and
Stroke (NINDS) rt-PA study group. We included the patients
arriving after time window for thrombolysis, so as to study
the causes associated with pre-hospital delay. Thrombolysis
therapy was given within four and a half hours of the stroke
onset.
Results: Among a total of 223 study subjects, only 13 (5.8%)
arrived within the time window for rt-PA infusion and nine (4%)
received thrombolytic therapy. The pre-hospital delay was the
single most important constraint for providing timely stroke
treatment. ‘Lack of awareness of patients and their relatives
to recognize stroke as a medical emergency’ and ‘lack of
awareness about thrombolysis’ were the most important
factors associated with the pre-hospital delay. Non-affordability
and in-hospital delays were the barriers for successful stroke
treatment among the patients who presented to the medical
emergency on time and could not get thrombolytic therapy.
Conclusion: The results of our study suggest the need for a
comprehensive stroke care program at our health center to
escalate the rate of thrombolytic therapy. Stroke education
and awareness modules should be incorporated in the stroke
program. |
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| ISSN: | 2249-782X 0973-709X |