Barriers to Stroke Thrombolysis

Abstract

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.

Keywords

• ischaemic stroke
• thrombolytic therapy
• tissue plasminogen activator