Barriers of Thrombolysis Therapy in Developing Countries

Abstract

The developing world carries the highest burden of stroke mortality and stroke-related disability. The number of stroke patients receiving r-tPA in the developing world is extremely low. Prehospital delay, financial constraints, and lack of infrastructure are main barriers of thrombolysis therapy in developing countries. Until a cheaper thrombolytic agent and the proper infrastructure for utilization of thrombolytic therapy is available, developing countries should focus on primary and secondary stroke prevention strategies. However, governments and health systems of developing countries should efforts exerb for promotion of their infrastructure of stroke care.

Gaps and Hurdles Deter against Following Stroke Guidelines for Thrombolytic Therapy in Iran: Exploring the Problem

“…17 In comparison, access to rtPA in Iran is lower than in most of the developed countries [18][19][20][21][22][23][24][25] but comparable with other developing countries [26][27][28][29][30][31][32] ( Fig 2). The barriers of timely administration of rtPA in developing countries include limited resources, prehospital delay, sparse numbers of stroke units, 16,33 poor stroke awareness in the general population, 33 lack of general knowledge and professional education, 33,34 the high cost of rtPA, lack of insurance coverage, low socioeconomic status of patients, 16,33 and physician reluctance and concerns about the benefits compared with its serious side effects, especially bleeding. [34][35][36] Time from symptom onset to hospital arrival is the most important factor in choosing the right patients for thrombolytic therapy.…”

Strategies to Improve Stroke Care Services in Low- and Middle-Income Countries: A Systematic Review

“…Since the cost of tPA is a limiting factor [88], government subsidy or free provision of tPA in government hospitals can improve thrombolysis rate. The government can also include it in medical insurance.…”

In VitroCharacterization of a Multifunctional Staphylokinase Variant with Reduced Reocclusion, Produced from Salt InducibleE. coliGJ1158

“…Further, the reoccluded clots are usually platelet rich and resistant to some thrombolytic agents such as t-PA due to presence of platelet plasminogen activator inhibitor-1 (PAI-1) released by platelets [4]. Although the widely used t-PA offers good clinical efficacy and higher survival rates compared to currently approved drugs, only a few patients are able to afford its much higher cost ($US1400 per person) [5]. Hence, the choice of more potent thrombolytic drugs, which provide a fast and complete reperfusion with minimal side effects at low cost, is needed.…”