Acute Stroke Care in Pakistan

Farooq, Anjum; Ahmed, Saima; Wasay, Mohammad

doi:10.29271/jcpsp.2022.06.695

J Coll Physicians Surg Pak

2022

DOI: 10.29271/jcpsp.2022.06.695

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Acute Stroke Care in Pakistan

Anjum Farooq¹,

Saima Ahmed

Mohammad Wasay

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2023

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Cited by 4 publications

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“…It seems to be challenging due to the following reasons: There is a lack of infra-structure for stroke care in Pakistan. 6,7 There are only 10 stroke units throughout the country of which, only 6 institutions offer IV thrombolytics. There is no concept of "Code Stroke" as reaching the time matrices is near-impossible.…”

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confidence: 99%

Tele-stroke care in Pakistan

Karim

2023

PJNS

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confidence: 99%

Tele-stroke care in Pakistan

Karim

2023

PJNS

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“…Studies claim that only six hospitals in Pakistan currently offer intravenous thrombolytic therapy with alteplase, all being private tertiary care hospitals. 5 While the world is adopting Tenecteplase instead of alteplase because of its better results, a more favourable side effects profile, and lower cost, our healthcare system is still dependent on SK for IV thrombolysis in cases of STEMI, which too is sometimes not available in many hospitals.…”

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Urgent need for the introduction of Tenecteplase in Pakistan: A Call to action for improved stroke and Mi Care

Yousaf,

Hamza Naeem,

Shahid

2023

J Pak Med Assoc

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Madam, Tenecteplase is a recombinant tissue plasminogen activator (tPA) that is used in many countries worldwide for reperfusion in acute ischemic stroke (AIS) and STEMI because of its longer half-life and high fibrin specificity compared to other tPAs (e.g., alteplase) and Streptokinase.1 Tenecteplase binds with fibrin-rich clots using its fibronectin finger-like and kringle-2 domains. The binding allows the protease domain to cleave the Arg/Val bond, converting plasminogen into plasmin, which breaks the fibrin matrix of the thrombus, resulting in clot dissolution. While Stroke and MI remain in the top 5 leading causes of death in Pakistan2, this highly efficient thrombolytic agent is not yet accessible in most hospitals for reperfusion in acute ischemic stroke and myocardial infarction cases. Many studies offer promising results, with tenecteplase being a better thrombolytic agent for acute ischemic stroke and STEMI than alteplase. In India, studies declare tenecteplase effective and safe in STEMI patients with clinically successful thrombolysis reported in 80.67% of patients, while intracranial hemorrhage associated with tenecteplase was only 0.39%.3 Tenecteplase is more efficient and at least as safe as alteplase for acute ischemic stroke. According to a meta-analysis involving 2031 patients, the patients given Tenecteplase showed higher recanalization rates (ARD=0.11, 95%CI) and early neurological improvement (ARD=0.10, 95% CI) compared to patients given alteplase.4 Tenecteplase also has a lower cost and a more favorable pharmacokinetic profile allowing bolus injection. Regrettably, Tenecteplase is not yet accessible in Pakistan due to unclear political and administrative factors, and border restrictions. Studies claim that only six hospitals in Pakistan currently offer intravenous thrombolytic therapy with alteplase, all being private tertiary care hospitals.5 While the world is adopting Tenecteplase instead of alteplase because of its better results, a more favourable side effects profile, and lower cost, our healthcare system is still dependent on SK for IV thrombolysis in cases of STEMI, which too is sometimes not available in many hospitals. In light of available evidence suggesting Tenecteplase as a better alternative to alteplase and Streptokinase, the health government and hospital policymakers should consider introducing tenecteplase in Pakistan as the standard care for STEMI, New Onset LBBB (Left Bundle Branch Block), Acute Ischemic Stroke, Prosthetic Valve Thrombosis, Pulmonary Embolism, and Deep Venous Thrombosis.

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Global, regional, and national time trends in mortality for stroke, 1990–2019: An age-period-cohort analysis for the global burden of disease 2019 study and implications for stroke prevention

Peng

Liu

Cao

et al. 2023

International Journal of Cardiology

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Acute Stroke Care in Pakistan

Cited by 4 publications

References 0 publications

Tele-stroke care in Pakistan

Tele-stroke care in Pakistan

Urgent need for the introduction of Tenecteplase in Pakistan: A Call to action for improved stroke and Mi Care

Global, regional, and national time trends in mortality for stroke, 1990–2019: An age-period-cohort analysis for the global burden of disease 2019 study and implications for stroke prevention

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