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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.

Subject Area

Neuropsychiatry

Article Type

Original Study

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