Factors Influencing Nonadministration of Thrombolytic Therapy in Early Arrival Strokes in a University Hospital in Hyderabad, India

Overview

Journal Ann Indian Acad Neurol

Specialty Neurology

Date 2016 Aug 30

PMID 27570387

Citations 2

Authors

Lalitha Pidaparthi

Anitha Kotha

Venkat Reddy Aleti

Abhijeet Kumar Kohat

Mridula R Kandadai

Suryaprabha Turaga

Jabeen A Shaik

Suvarna Alladi

Meena A Kanikannan

Borgohain Rupam

Subhash Kaul

Affiliations

Soon will be listed here.

Abstract

Background: It is a well-known fact that very few patients of stroke arrive at the hospital within the window period of thrombolysis. Even among those who do, not all receive thrombolytic therapy.

Objective: The objectives of this study were to determine the proportion of early arrival ischemic strokes (within 6 h of stroke onset) in our hospital and to evaluate the causes of nonadministration of intravenous and/or intraarterial thrombolysis in them.

Materials And Methods: Data of all early arrival acute stroke patients between January 2010 and January 2015 were included. Factors determining nonadministration of intravenous and/or intraarterial thrombolysis in early arrival strokes were analyzed.

Results: Out of 2,593 stroke patients, only 145 (5.6%) patients presented within 6 h of stroke onset and among them 118 (81.4%) patients had ischemic stroke and 27 (18.6%) patients had hemorrhagic stroke. A total of 89/118 (75.4%) patients were thrombolyzed. The reasons for nonadministration of thrombolysis in the remaining 29 patients were analyzed, which included unavoidable factors in 8/29 patients [massive infarct (N = 4), hemorrhagic infarct (N = 1), gastrointestinal bleed (N = 1), oral anticoagulant usage with prolonged international normalized ratio (INR) (N = 1), and recent cataract surgery (N = 1)]. Avoidable factors were found for 21/29 patients, include nonaffordability (N = 7), fear of bleed (N = 4), rapidly improving symptoms (N = 4), mild stroke (N = 2), delayed neurologist referral within the hospital (N = 2), and logistic difficulty in organizing endovascular treatment (N = 2).

Conclusion: One-fourth of early ischemic stroke patients in our study were not thrombolyzed even though they arrived within the window period. The majority of the reasons for nonadministration of thrombolysis were potentially preventable, such as nonaffordability, intrahospital delay, and nonavailability of newer endovascular interventions.

Citing Articles

Stumbling Blocks to Stroke Thrombolysis: An Indian Perspective.

Shah A, Diwan A Indian J Crit Care Med. 2023; 27(9):616-619.

PMID: 37719355 PMC: 10504641. DOI: 10.5005/jp-journals-10071-24517.

Quality Indicators of Intravenous Thrombolysis from North India.

William A, Pannu A, Kate M, Jaison V, Gupta L, Bose S Ann Indian Acad Neurol. 2017; 20(4):393-398.

PMID: 29184343 PMC: 5682744. DOI: 10.4103/aian.AIAN_277_17.

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