Key result
Only 3.1% of acute ischemic stroke patients qualify for IV thrombolysis due to in-hospital delays.
Why the study?
Intravenous thrombolysis is less frequently used in developing countries for acute ischemic stroke despite guideline recommendations, and barriers to its implementation are unclear.
Cross-Sectional (n=647)
No
In-hospital delays in initial assessment, CT scans, and laboratory studies are major barriers to administering intravenous thrombolytic therapy for acute ischemic stroke in this setting.
Answers are grounded in this paper and cite their sources.
In-hospital delays limit thrombolysis eligibility; leaves open whether workflow interventions can improve rates in similar settings.
BACKGROUND: Intravenous thrombolysis is an approved treatment method for patients with acute ischemic stroke (AIS) and is recommended by multiple guidelines. However, it seems that it is less frequently used in the developing countries compared to the developed countries. OBJECTIVES: The purpose of this study was to estimate the percentage of patients with AIS, eligible for intravenous thrombolytic therapy, at the main referral center in Northwest Iran and to determine the main barriers for implementation of this method. PATIENTS AND METHODS: Over one year, 647 patients who were admitted to the emergency department and met the Cincinnati Stroke Scale were enrolled into the study. The center to which patients were admitted, is a tertiary university hospital that has the required infrastructure for thrombolytic therapy in AIS. Factors recorded were neurological examinations and time between onset of symptoms and hospital arrival, hospital arrival and performance of brain computed tomography (CT) scanning, and hospital arrival to complete the investigations. Patients eligible for intravenous thrombolytic therapy were identified according to the American Heart Association (AHA) guidelines. RESULTS: Mean time interval between hospital arrival and completion of brain CT scanning was 91 minutes (range: 20-378 minutes) and mean time from hospital arrival to completion of investigations was 150 minutes (range: 30-540 minutes). A total of 159 (31.3%) patients arrived at hospital within 3 hours of the onset of symptoms (early enough for intravenous thrombolytic therapy). However, 81.7% (130/159) of these patients missed thrombolytic therapy due to delayed performance of brain CT scanning and laboratory tests and 38.3% (61/159) had contraindications. The remaining 16 patients (10% of those who arrived within 3 hours and 3.1% of all cases) were eligible for thrombolytic therapy. CONCLUSIONS: The major barriers for thrombolytic therapy for patients with AIS in this setting were delays in the provision of in-hospital services, like initial patient assessment, CT scans or laboratory studies. These results were in contrast with previous reports.
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Ayromlou et al. (2014) conducted a cross-sectional in Acute ischemic stroke (AIS) (n=647). Intravenous thrombolytic therapy was evaluated on Eligibility for intravenous thrombolytic therapy. Only 3.1% of acute ischemic stroke patients were eligible for intravenous thrombolysis, primarily due to in-hospital delays in CT scanning and laboratory tests.
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