Outcomes of stroke patients undergoing thrombolysis in Sri Lanka; an observational prospective study from a low-middle income country
Abstract Background Stroke related deaths are relatively higher in low- and middle-income countries where only a fraction of eligible patients undergo thrombolysis. There is also limited evidence on post-thrombolysis outcomes of patients from Asian countries in these income bands. Methods This is a...
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| Language: | English |
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BMC
2021-11-01
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| Series: | BMC Neurology |
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| Online Access: | https://doi.org/10.1186/s12883-021-02475-3 |
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| author | H. M. M. T. B. Herath Chaturaka Rodrigo A. M. B. D. Alahakoon Sathyajith Buddhika Ambawatte Sunethra Senanayake Bimsara Senanayake Arjuna Fernando |
| author_facet | H. M. M. T. B. Herath Chaturaka Rodrigo A. M. B. D. Alahakoon Sathyajith Buddhika Ambawatte Sunethra Senanayake Bimsara Senanayake Arjuna Fernando |
| author_sort | H. M. M. T. B. Herath |
| collection | DOAJ |
| description | Abstract Background Stroke related deaths are relatively higher in low- and middle-income countries where only a fraction of eligible patients undergo thrombolysis. There is also limited evidence on post-thrombolysis outcomes of patients from Asian countries in these income bands. Methods This is a single center prospective observational study of a patient cohort with acute ischaemic stroke, undergoing thrombolysis with alteplase (low and standard dose), over a 24-month period in 2019/2020. Modified Rankin scale (mRS) for dependency at 3 months (primary outcome), duration of hospital stay, incidence of symptomatic intracranial haemorrhages and all-cause mortality at 3 months (secondary outcomes) were recorded. Demographic, clinical and treatment related factors associated with these outcomes were explored. Results Eighty-nine patients (males – 61, 69%, mean age: 60 years ±12.18) were recruited. Time from symptom onset to reperfusion was 174 min ± 56.50. Fifty-one patients were independent according to mRS, 11 (12.4%) patients died, and 11 (12.5%) developed symptomatic intracranial haemorrhages by 3 months. Functional independence at 3 months was independently associated with National Institutes of Health Stroke Scale (NIHSS) on admission (p < 0.05). Thrombolysis with low dose alteplase did not lead to better or worse outcomes compared to standard dose. Conclusions On admission NIHSS is predictive of functional independence at 3 months post-thrombolysis. Low dose alteplase may be as efficacious as standard dose alteplase with associated cost savings, but this needs to be confirmed by a prospective clinical trial for the Sri Lankan population. |
| first_indexed | 2024-12-17T02:18:33Z |
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| institution | Directory Open Access Journal |
| issn | 1471-2377 |
| language | English |
| last_indexed | 2024-12-17T02:18:33Z |
| publishDate | 2021-11-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Neurology |
| spelling | doaj.art-b1289c10e8ef4d2bb5c14a26c8e816252022-12-21T22:07:19ZengBMCBMC Neurology1471-23772021-11-012111910.1186/s12883-021-02475-3Outcomes of stroke patients undergoing thrombolysis in Sri Lanka; an observational prospective study from a low-middle income countryH. M. M. T. B. Herath0Chaturaka Rodrigo1A. M. B. D. Alahakoon2Sathyajith Buddhika Ambawatte3Sunethra Senanayake4Bimsara Senanayake5Arjuna Fernando6Neurology Department, National Hospital of Sri LankaDepartment of Pathology, School of Medical Sciences, UNSW SydneyNeurology Department, National Hospital of Sri LankaNeurology Department, National Hospital of Sri LankaNeurology Department, National Hospital of Sri LankaNeurology Department, National Hospital of Sri LankaNeurology Department, National Hospital of Sri LankaAbstract Background Stroke related deaths are relatively higher in low- and middle-income countries where only a fraction of eligible patients undergo thrombolysis. There is also limited evidence on post-thrombolysis outcomes of patients from Asian countries in these income bands. Methods This is a single center prospective observational study of a patient cohort with acute ischaemic stroke, undergoing thrombolysis with alteplase (low and standard dose), over a 24-month period in 2019/2020. Modified Rankin scale (mRS) for dependency at 3 months (primary outcome), duration of hospital stay, incidence of symptomatic intracranial haemorrhages and all-cause mortality at 3 months (secondary outcomes) were recorded. Demographic, clinical and treatment related factors associated with these outcomes were explored. Results Eighty-nine patients (males – 61, 69%, mean age: 60 years ±12.18) were recruited. Time from symptom onset to reperfusion was 174 min ± 56.50. Fifty-one patients were independent according to mRS, 11 (12.4%) patients died, and 11 (12.5%) developed symptomatic intracranial haemorrhages by 3 months. Functional independence at 3 months was independently associated with National Institutes of Health Stroke Scale (NIHSS) on admission (p < 0.05). Thrombolysis with low dose alteplase did not lead to better or worse outcomes compared to standard dose. Conclusions On admission NIHSS is predictive of functional independence at 3 months post-thrombolysis. Low dose alteplase may be as efficacious as standard dose alteplase with associated cost savings, but this needs to be confirmed by a prospective clinical trial for the Sri Lankan population.https://doi.org/10.1186/s12883-021-02475-3StrokeThrombolysisSri LankaObservational prospective study |
| spellingShingle | H. M. M. T. B. Herath Chaturaka Rodrigo A. M. B. D. Alahakoon Sathyajith Buddhika Ambawatte Sunethra Senanayake Bimsara Senanayake Arjuna Fernando Outcomes of stroke patients undergoing thrombolysis in Sri Lanka; an observational prospective study from a low-middle income country BMC Neurology Stroke Thrombolysis Sri Lanka Observational prospective study |
| title | Outcomes of stroke patients undergoing thrombolysis in Sri Lanka; an observational prospective study from a low-middle income country |
| title_full | Outcomes of stroke patients undergoing thrombolysis in Sri Lanka; an observational prospective study from a low-middle income country |
| title_fullStr | Outcomes of stroke patients undergoing thrombolysis in Sri Lanka; an observational prospective study from a low-middle income country |
| title_full_unstemmed | Outcomes of stroke patients undergoing thrombolysis in Sri Lanka; an observational prospective study from a low-middle income country |
| title_short | Outcomes of stroke patients undergoing thrombolysis in Sri Lanka; an observational prospective study from a low-middle income country |
| title_sort | outcomes of stroke patients undergoing thrombolysis in sri lanka an observational prospective study from a low middle income country |
| topic | Stroke Thrombolysis Sri Lanka Observational prospective study |
| url | https://doi.org/10.1186/s12883-021-02475-3 |
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