Tissue plasminogen activator; identifying major barriers related to intravenous injection in ischemic acute cerebral infraction

Abstract

Background:According to previous publications, in patients with acute ischemic cerebral infarction, thrombolytic therapy using intravenous tissue plasminogen activator (IV-tPA) necessitates precise documentation of symptoms’ onset. The aim of this study was to identify major barriers related to the IV-tPA injection in such patients.Materials and Methods:Between the year 2014-2015, patients with definitive diagnosis of acute cerebral infarction (n = 180) who attended the neurology ward located at the Isfahan Alzahra Hospital were studied. To investigate barriers related to door to IV-tPA needle time, personal reasons, and criteria for inclusion or exclusion of patients, three questionnaire forms were designed based on the Food and Drug Administration-approved indications or contraindications.Results:The mean age of males versus females was 60 versus 77.5 years (ranged 23–93 vs. 29–70 years), respectively. Out of total population, only 10.7% transferred to hospital in <4.5 h after the onset of symptoms. Regarding to eligibility for IV-tPA, 68.9% of total population have had criteria for such treatment. Concerning to both items such as transferring to hospital in <4.5 h after the onset of symptoms and eligibility for IV-tPA, only 6.6% of total population met the criteria for such management. There was ignorance or inattention to symptoms in 75% of population studied. There was a mean of 195.92 ± 6.65 min (182.8–209.04 min) for door to IV-tPA needle time.Conclusion:Despite the international guidelines for IV-tPA injection within 3–4.5 h of ischemic stroke symptoms’ onset, the results of this study revealed that falling time due to ignorance of symptoms, literacy, and living alone might need further attention. As a result, to decrease death and disability, educational programs related to the symptoms’ onset by consultant neurologist in Isfahan/Iran seem to be advantageous.

Factors affecting time between symptom onset and emergency department arrival in stroke patients

“…Despite the availability of these interventions, the national average tPA usage rate is only 5–6% [ 5 , 6 ] and less than 1% for endovascular thrombectomy [ 7 ]. The most common reason for exclusion from acute treatment is arrival to ED outside of the designated time window [ 8 ].…”

Intra‐arterial combination therapy for experimental acute ischemic stroke

“…tPA), but it has shown limited effect on large vessel occlusions, 6 and has significant exclusion criteria (most notably an administration window of 4.5 h from last known normal). 7 , 8 , 9 Recent clinical trials using mechanical thrombectomy (MT), or the endovascular removal of the clot, have demonstrated increased recanalization rates with fewer exclusion criteria leading to greater patient benefit. 10 , 11 , 12 Although i.v.…”