Door-to-Needle Time and the Factors Impeding Thrombolysis of Acute Stroke Patients at a Tertiary Care Center in India

Abstract

Background: Intravenous thrombolysis for acute ischemic stroke is time-sensitive with a narrow window period for treatment initiation. The recommended Door-to-needle (DTN) time of <60 minutes is seldom achieved in Indian centers. In this study, we aimed to evaluate the DTN time at our hospital and identify the factors that limit thrombolysis of acute stroke patients. Materials and Methods: All patients that presented with signs of stroke from September to December 2019 were studied. Patient's demographics, details of symptoms, time of symptom onset, and contraindications to thrombolysis were recorded. The Symptom-to-Door, Doorto-Physician, Door-to-Imaging and Door-to-Needle times were calculated from key temporal data. The factors that inuenced the DTN time were also recorded. Results: Out of the 241 patients that presented with symptoms of stroke, 43 (17.8%) were within the window period. Nine patients were thrombolysed and among these, one (11.1%) was started on rt-PA within 1 hour of arrival. The mean DTN time was 112 minutes (median - 102 minutes). Conclusion: The DTN time in this study was much higher than what is recommended. The major factors that impede thrombolysis are: ignorance among the public, lack of a proper triage system at various levels, and lack of a dedicated stroke protocol/team.