Key result
IV thrombolysis yields good 6-month functional outcomes in ~75% of acute stroke patients.
Why the study?
Data on intravenous thrombolysis using tissue plasminogen activator are limited from low- and middle-income countries.
Cohort (n=4,720)
No
Intravenous thrombolysis for stroke in a North Indian center showed improving process times and good clinical outcomes, though door-to-needle times and financial barriers remain areas for improvement.
Answers are grounded in this paper and cite their sources.
Supports thrombolysis feasibility in North Indian centers; extends observational data but remains hypothesis-generating for practice change.
BACKGROUND: Data on intravenous (IV) thrombolysis using tissue plasminogen activator (tPA) are limited from low- and middle-income countries. We aimed to assess the quality indicators of IV thrombolysis in our stroke unit. METHODS: All stroke patients admitted in our hospital from October 2008 to April 2017 were included in this study. Data were collected prospectively by trained research staff in a detailed case record form. Outcome was assessed using modified Rankin Scale (mRS, 0-1 good outcome). RESULTS: Of the total 4720 stroke patients seen, 944 (20%) came within window period (<4.5 h). Of these, 214 (4.5%) were eligible for thrombolysis and 170 (3.6%) were thrombolysed, relatives of 23 (23/214, 10.7%) patients denied consent, and 21 (9.8%) patients could not afford tPA. The mean age of thrombolysed patients was 58.4 (range 19-95) years. Median NIHSS at admission was 12 (interquartile range 2-24). Average onset-to-door (O-D) time was 76.8 (5-219) min, door-to-examination (D-E) time was 17.8 (5-105) min, door-to-CT (D-CT) time was 48 (1-205) min, and door-to-needle (D-N) time was 90 (20-285) min. At 6 months, 110 (64.7%) patients were contactable and 82 (74.5%) patients had good outcome (mRS 0-1). CONCLUSION: Thrombolysis rate has steadily increased at the center without undue adverse effects even in the elderly. D-E and D-CT times have reduced, but O-D and D-N times need further improvement. More patients could be thrombolysed if the cost of tPA is reduced and the consent process is waived.
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Pannu et al. (2017) conducted a cohort in Stroke (n=4,720). Intravenous thrombolysis using tissue plasminogen activator (tPA) was evaluated on Good outcome (modified Rankin Scale 0-1) at 6 months. Among stroke patients receiving intravenous thrombolysis at a North Indian center, 74.5% of those contactable at 6 months achieved a good functional outcome (mRS 0-1).
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