Quality indicators of intravenous thrombolysis from North India

Abstract

Background:Data on intravenous (IV) thrombolysis using tissue plasminogen activator (tPA) are limited from low- and middle-income countries. We aimed to assess the quality indicators of IV thrombolysis in our stroke unit.Methods:All stroke patients admitted in our hospital from October 2008 to April 2017 were included in this study. Data were collected prospectively by trained research staff in a detailed case record form. Outcome was assessed using modified Rankin Scale (mRS, 0–1 good outcome).Results:Of the total 4720 stroke patients seen, 944 (20%) came within window period (<4.5 h). Of these, 214 (4.5%) were eligible for thrombolysis and 170 (3.6%) were thrombolysed, relatives of 23 (23/214, 10.7%) patients denied consent, and 21 (9.8%) patients could not afford tPA. The mean age of thrombolysed patients was 58.4 (range 19–95) years. Median NIHSS at admission was 12 (interquartile range 2–24). Average onset-to-door (O-D) time was 76.8 (5–219) min, door-to-examination (D-E) time was 17.8 (5–105) min, door-to-CT (D-CT) time was 48 (1–205) min, and door-to-needle (D-N) time was 90 (20–285) min. At 6 months, 110 (64.7%) patients were contactable and 82 (74.5%) patients had good outcome (mRS 0–1).Conclusion:Thrombolysis rate has steadily increased at the center without undue adverse effects even in the elderly. D-E and D-CT times have reduced, but O-D and D-N times need further improvement. More patients could be thrombolysed if the cost of tPA is reduced and the consent process is waived.

Stroke systems of care in South-East Asia Region (SEAR): commonalities and diversities

“… 16 , 17 Dismal rates of IVT usage from 0.5 to 3.6% have been reported by various region-specific studies from India. 18 , 19 The more recent Indo-US registry reports a thrombolysis rate of 11.5%; however, representing only five major tertiary institutes of the country, this data is unlikely to truly reflect the national thrombolysis rates. 20 …”

“…Refusal to consent (10.7%) and unaffordability (9.8%) were reported in a study from Northwest India. 18 Compared to HICs, striking disparities exist in the availability of neurologists in Southeast Asia. With fewer than 4500 neurologists in the entire region, most SEAR countries have an average of 1 neurologist per 1 million population.…”

Expert Consensus on Improving Stroke Care Ecosystem in India

“…In India, only 35-50 Sus are available, and nearly 2,000 patients receive thrombolysis every year due to various challenges. 78 Most stroke patients cannot receive thrombolysis due to delayed hospital arrival, lack of early access to scanning facilities, inadequate infrastructure and high cost of thrombolytic and/or endovascular therapy. 79 Following the emergence of the COVID-19 pandemic, there was a 6.1% absolute reduction in IVT.…”