Thrombolytic Treatment in Thailand

Suwanwela, Nijasri C.; Chutinet, Aurauma; Kijpaisalratana, Naruchorn

doi:10.1177/2516608518777934

Cited by 9 publications

(16 citation statements)

References 6 publications

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“…Encouragingly there are a growing number of MSU programmes in LMIC settings. For example, in Thailand, a stroke fast track programme, telestroke, and two MSUs in Bangkok are improving stroke care (121). Inclusion of MSUs should be considered as part of long-term planning for stroke service improvement in these settings.…”

Section: Improving Prehospital Stroke Care In Low and Middle-income Cmentioning

confidence: 99%

Improving Prehospital Stroke Services in Rural and Underserved Settings With Mobile Stroke Units

et al. 2019

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In acute stroke management, time is brain, as narrow therapeutic windows for both intravenous thrombolysis and mechanical thrombectomy depend on expedient and specialized treatment. In rural settings, patients are often far from specialized treatment centers. Concurrently, financial constraints, cutting of services and understaffing of specialists for many rural hospitals have resulted in many patients being underserved. Mobile Stroke Units (MSU) provide a valuable prehospital resource to rural and remote settings where patients may not have easy access to in-hospital stroke care. In addition to standard ambulance equipment, the MSU is equipped with the necessary tools for diagnosis and treatment of acute stroke or similar emergencies at the emergency site. The MSU strategy has proven to be effective at facilitating time-saving stroke triage decisions. The additional on-board imaging helps to determine whether a patient should be taken to a primary stroke center (PSC) for standard treatment or to a comprehensive stroke center (CSC) for advanced stroke treatment (such as intra-arterial therapy) instead. Diagnosis at the emergency site may prevent additional in-hospital delays in workup, handover and secondary (inter-hospital) transport. MSUs may be adapted to local needs—especially in rural and remote settings—with adjustments in staffing, ambulance configuration, and transport models. Further, with advanced imaging and further diagnostic capabilities, MSUs provide a valuable platform for telemedicine (teleradiology and telestroke) in these underserved areas. As MSU programmes continue to be implemented across the world, optimal and adaptable configurations could be explored.

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Section: Improving Prehospital Stroke Care In Low and Middle-income Cmentioning

confidence: 99%

Improving Prehospital Stroke Services in Rural and Underserved Settings With Mobile Stroke Units

et al. 2019

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“…The Ministry of Public Health and the National Health Security Office (NHSO) had accepted the use of intravenous thrombolysis as the standard treatment of acute ischemic stroke in 2008. Therefore, the cost of the treatment can be totally reimbursed for all Thai citizens by 3 main payers including the universal coverage program by NHSO, the Social Security Office, and the Comptroller General's Department for the government officers [5]. Since then the stroke fast track system has been implemented throughout the country.…”

Section: Introductionmentioning

confidence: 99%

Outcomes of thrombolytic therapy in acute ischemic stroke: mothership, drip-and-ship, and ship-and-drip paradigms

et al. 2020

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Background: Chulalongkorn Stroke Center is a comprehensive stroke center (CSC) located in Bangkok, Thailand. Our stroke network consists of different levels of spoke hospitals, ranging from community hospitals where thrombolytic treatment is not available, to those capable of onsite thrombolytic therapy. This study aimed to assess the time to treatment and outcomes among acute ischemic stroke patients who received thrombolytic treatment in the Chulalongkorn Stroke Network by 1.) Direct arrival at the CSC (mothership) 2.) Telestroke-assisted thrombolytic treatment with secondary transfer to the CSC (drip-and-ship) 3.) Referral from community hospital to the CSC for thrombolytic treatment (ship-and-drip).Methods: Acute ischemic stroke patients who received thrombolytic treatment during January 2016-December 2017 in the Chulalongkorn Stroke Network were studied. Time to treatment and clinical outcomes were compared among treatment groups.Results: There were 273 patients in the study including 147, 87, and 39 patients in mothership, drip-and-ship, and shipand-drip paradigms, respectively. The door-to-needle-time (DTN) and onset-to-needle-time (OTN) times were significantly longest in ship-and-drip group (146.5 ± 62/205.03 ± 44.88 mins) compared to mothership (38 ± 23/155.2 ± 60.54 mins) and drip-and-ship (63.0 ± 44/166.09 ± 87 mins), P < 0.05. There was no significant difference regarding functional independence defined by modified Rankin Scale (mRS) ≤ 2 at 3 months (P = 0.12), in-hospital mortality (P = 0.37), mortality at 3 months (P = 0.73), and symptomatic intracerebral hemorrhage (P = 0.24) among groups.Conclusion: Thrombolytic treatment with drip and ship method under teleconsultation is feasible in Thailand. There was no difference of clinical outcome among the 3 treatment paradigms. However, DTN time and OTN time were longest in the ship-and-drip paradigm.

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“…This percentage varies between the centers, as high as 15–16% in some tertiary care centers. 17 Still, not everyone that receives treatment always has an excellent functional outcome. Hence, our study objective is to find which factor in the patient is associated with unfavorable outcomes after IVT because each person has a different background and characteristics.…”

Section: Discussionmentioning

confidence: 99%

“…Apart from onset to treatment time, in-hospital complications, and elderly age, clinical and neuroimaging parameters from our model illustrate important prognostic factors related to functional outcomes after stroke. 17 , 32 , 38 Besides these predictive models, we should be focused on stroke screening, prevention, and a better control system to improve stroke patients’ outcomes. Recently, fascinating data from China Stroke Prevention Project Committee (CSPPC) provides an unquestionable benefit of three 1-h gold rescue circles (less than 1-h for onset to call time, pre-hospital transfer time, and door-to-needle time) for stroke treatment and should be further promoted worldwide, especially for other developing countries, to improved stroke care.…”

Section: Discussionmentioning

confidence: 99%

Factors Associated with Unfavorable Functional Outcomes After Intravenous Thrombolysis in Patients with Acute Ischemic Stroke

Satumanatpan¹,

Tonpho²,

Thiraratananukulchai³

et al. 2022

IJGM

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Purpose Intravenous thrombolysis (IVT) has become a standard treatment for eligible ischemic stroke patients. However, functional outcomes after receiving IVT varied widely. Hence the primary goal of this study is to identify characteristics related to poor outcomes. Patients and Methods The study enrolled acute ischemic stroke patients aged 18 or older who received IVT within 4.5 hours after onset between January 2018 and December 2020. The data were retrospectively collected from medical records. The patients were classified as having an excellent (0–2) or poor (3–6) outcomes based on the 90-day modified Rankin Scale (mRS). Univariable and multivariable logistic regression analyses were used to evaluate the results. The predictive model was determined and developed the score using regression coefficients. The prediction power was validated using the area under the receiver operating characteristic curve analysis. Results The study included 138 eligible participants. Forty-eight patients had unfavorable functional outcomes. With multivariable logistic regression analysis, factors significantly associated with poor outcomes were age (adjusted odds ratio (AOR), 1.03; 95% confidence interval (CI), 0.99–1.07; P = 0.05), diabetes (3.96; 1.61–9.37; P = 0.003), admission National Institute of Health Stroke Scale (NIHSS) (1.08; 1.01–1.15; P = 0.02) and initial Alberta Stroke Program Early Computed Tomography Score (ASPECTS) (0.56; 0.37–0.86; P = 0.009). The predictive model developed from the findings demonstrated good discrimination power (AuROC 0.803, 95% CI 0.728–0.877). Conclusion The current study found that older age, diabetes, atrial fibrillation, higher admission NIHSS, and lower ASPECTS on the initial NCCT brain were related to unfavorable functional outcomes following IVT and served as good predictors of patient functional outcomes.

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Thrombolytic Treatment in Thailand

Cited by 9 publications

References 6 publications

Improving Prehospital Stroke Services in Rural and Underserved Settings With Mobile Stroke Units

Improving Prehospital Stroke Services in Rural and Underserved Settings With Mobile Stroke Units

Outcomes of thrombolytic therapy in acute ischemic stroke: mothership, drip-and-ship, and ship-and-drip paradigms

Factors Associated with Unfavorable Functional Outcomes After Intravenous Thrombolysis in Patients with Acute Ischemic Stroke

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