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Subject Area

Neuropsychiatry

Article Type

Original Study

Abstract

Objectives To identify barriers against thrombolytic therapy of acute ischemic stroke (AIS) and to evaluate its efficacy and complications in Egypt. Background Tissue plasminogen activator is the only FDA-approved thrombolytic therapy for AIS. However, its use in Egypt is below best practice benchmarks. Patients and methods In a cohort observational study, 120 patients with AIS were recruited from the stroke unit of Menoufia University Hospitals and were divided into three groups: group A included 40 patients who received intravenous thrombolysis (IVT), group B included 40 patients who were eligible but did not receive IVT, and group C included 40 patients who came after 4.5 h but within 24 h of stroke onset. Causes of prehospital and in-hospital delay were recorded. Complications and outcomes using NIHSS and mRS were assessed. Results The most prevalent cause of prehospital delay (mean value 2.12 ± 1.09 h) was lack of awareness of the therapeutic window of IVT (85.8%), whereas in hospital delay (mean value 1.92 ± 0.87 h), it was the time wasted in hospital owing to lack of a well-constructed stroke service (52.5%). Regarding functional outcome, there was a statistically significant improvement in mRS after 3 months in the thrombolysed group (P = 0.00), whereas hemorrhagic transformation was noted in 11 (27.5%) of 40 patients. Conclusion Among the studied barriers against thrombolysis in AIS, lack of awareness of therapeutic window and defective well-structured hospital stroke service were the most common barriers. The clinical outcome was better in patients who received-tissue plasminogen activator, but the hemorrhagic transformation occurred in more than one-fourth of them.

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