Outcome of thrombolysis with recombinant tissue plasminogen activator (rtPA) in a rural tertiary care center

Abstract

Stroke is a leading cause of morbidity and mortality worldwide and there is a significant gap in the availability of standard of care in different regions especially in the rural areas. To assess the clinical profile and outcome of patients treated with iv rtPA at a rural tertiary care center. A prospective observational study of consecutive window period stroke patients treated with iv rtPA. Clinical, epidemiological, imaging parameters, outcome measures including baseline NIHSS, NIHSS at 1 hour, 24 hours, discharge and mRS [modified Rankin Score] at 1 and 3 months were entered in structured proforma. A total od 28 patients were thrombolysed with iv rtPA during the study period. Diabetes, Hypertension and smoking were the most common comorbidities. The mean arrival time in hospital was 151 minutes. The door to needle time was 68 minute. 22 had anterior circulation stroke and 6 with posterior circulation stroke. Mean NIHSS at arrival was 10.4. Mean NIHSS score at 24 hours was 10.1 and NIHSS at 7 days was 9.8. Major improvement as measured as a drop in NIHSS of 8 points was seen in 7 patients [25%]. The mean MRS at 1 month was 2.89 and at 3 months was 1.74. At 3 months follow up 10 out of 28 patients [35.7%] had major improvement characterized by mRS improvement of 3 from time of discharge or final mRS of 0 or 1. Thrombolysis with rtPA is safe and effective in rural setting.