Early Ischemic Stroke Presentation in Pakistan

Abstract

Recombinant tissue plasminogen activator (rtPA) is the only available therapy for acute ischemic stroke. Current clinical protocols limit its use to a three-hour window from symptom onset. The role of thrombolytic therapy between 91 and 180 minutes after stroke onset remains highly controversial. However, studies have shown that rtPA given within six hours of stroke reduced death or dependency (i.e. more patients alive and independent) at three to six months, and this was statistically significant in favor of treatment. [1][2][3][4] Late presentation continues to be a primary cause of exclusion from thrombolytic therapy ABSTRACT: Introduction: There are no studies from Pakistan that describe stroke presentation rates or factors associated with early or delayed presentation. This is important to know because current clinical protocols limit the use of recombinant tissue plasminogen activator (rtPA), the only available therapy for acute ischemic stroke, to a three-hour window from symptom onset. Methods: All patients aged 14 years or above with acute ischemic stroke of ≤ 48 hours duration were prospectively identified from the Aga Khan University Stroke Data Bank over a 22-month period ending May 2001. Results: 269 ischemic stroke patients presented within 48 hours of stroke onset. 55 out of 269 (21%) presented within first three hours and 110 out of 269 (41%) within first six hours. Unawareness of treatment options (p <0.001) and inappropriate diagnosis and field triage (p=0.005) were associated with delayed presentation. Small vessel occlusion or lacunar stroke in the TOAST (Trial of ORG 10172 in Acute Stroke Treatment) ischemic stroke subtype was associated with delayed presentation (p=0.047) and cardioembolic stroke was associated with earlier presentation (p=0.048). Stroke severity assessed with the National Institutes of Health Stroke Scale at a cut off score of ≥15 was not associated with earlier time to presentation at three hours (p=0.114) but there was some tendency at six hours (p=0.097). Conclusions: The rate of early stroke presentation in a Pakistani tertiary care facility is comparable to certain developed countries. To increase the proportion of patients who can benefit from thrombolytic therapy, programs need to be instituted to increase public awareness of treatment options for stroke and expedited referral by the primary care provider. cardioembolique était associé à une consultation plus précoce (p = 0,048). La sévérité de l'AVC évaluée au moyen du National Institutes of Health Stroke Scale avec un point de coupe de 15 et plus n'était pas associée à une consultation plus précoce dans le groupe qui avait consulté en dedans de 3 heures (p = 0,114), mais on notait une tendance en ce sens dans le groupe qui avait consulté en dedans de 6 heures (p = 0,097). Conclusions : Le taux de consultation précoce chez les patients présentant un AVC aigu dans les hôpitaux de soins tertiaires au Pakistan est comparable à celui de certains pays industrialisés. Il faudra établir des programmes d'information pour q...

Review of acute ischaemic stroke in Pakistan: progress in management and future perspectives

“…The fact that brain tissue is viable to be salvaged within a given period of time is the key concept in understanding why the time frame for delivering thrombolysis or intervention is so crucial in acute ischaemic stroke as shown in figure 4. [28][29][30][31][32][33][34][35][36][37][38][39][40] …”

“…For this, neurologists all over the country have put forward a petition to convince the government to ponder on this fragile situation. 4-6 20-26 [33][34][35][36][37][38] Intra-arterial thrombolysis Up until now, no centre in Pakistan has the expertise to offer intra-arterial rtPA. Various research publications have reported variable results for this mode of therapy and interest in its advancement is growing.…”

Acute Ischemic Stroke; Electrocardiographic and Echocardiographic Findings in Patients. (Potential Source of Cardiac Emboli)

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