Trends in the Use of Intravenous Recombinant Tissue Plasminogen Activator from Northwest India

Abstract

Lower incidence of vascular events following small artery ischemic stroke Small artery infarction, which is particularly prevalent among Asians (1), carries a lower risk of recurrent stroke at one-month compared with other stroke subtypes, but long-term findings are inconsistent (2,3). Data on subsequent myocardial infarction risk after small artery stroke are limited. We compared the incidence of vascular events following ischemic stroke due to small artery disease vs. other etiologies among prospectively recruited Asian patients admitted to the Singapore General Hospital from 2005 to 2007. Telephone follow᎑up at a median of 30 months (IQR 24-34) masked to clinical information was obtained for 89% of the cohort. Among the 731 patients with known stroke etiology, 49% had small artery infarction, 38% had large artery infarction, 12% had cardioembolic, and 1% had other etiology. Figure 1 shows the cumulative incidence of subsequent vascular events. Using Cox regression adjusted for age, gender, hypertension, diabetes, hyperlipidemia, smoking, and atrial fibrillation, small artery infarction was associated with a lower incidence of recurrent stroke [hazard ratio (HR) 0•62; P = 0•047], myocardial infarction (HR 0•45; P = 0•031), vascular death (HR 0•18; P = 0•002), and composite vascular events (HR 0•59, P = 0•007) compared with nonsmall artery stroke. The lower risk of subsequent vascular events following small artery infarction may be explained by a differing underlying pathology from large artery and

Quality indicators of intravenous thrombolysis from North India

“…[ 16 ] This pattern of using private vehicles is also seen in another study from the North India where 201 patients used ambulance services but 578 used private or public vehicles. [ 9 ] Mean O-D time in the current study was longer than the previous report from our center[ 11 ] but less than that of other reports from India. [ 13 19 ]…”

“…In this study, the overall thrombolysis rate was 3.6%, as compared to our earlier reports of 1% and 4.5%. [ 10 11 ] When the study period was dichotomized (October 2008–December 2012 and January 2013–April 2017), thrombolysis rate between the two study periods was nearly the same despite doubling in the absolute number of thrombolysed patients. This is due to a proportionate increase in the total number of stroke patients who came within the window period.…”

“…[ 23 ] Similar reasons for not thrombolysing eligible patients were observed in other studies from India. [ 9 11 13 ]…”

Predictors of severity and outcome and roles of intravenous thrombolysis and biomarkers in first ischemic stroke

“…Stroke severity was evaluated in the acute phase of the initial stroke by a neurologist certified in the use of the National Institute of Health Stroke Scale (NIHSS). Stroke severity by NIHSS [12] was categorized as mild (0-4), moderate (5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15), or severe . Furthermore, strokes were classified according to the Bamford criteria [13] in total anterior circulation stroke (TACS), partial anterior circulation stroke (PACS), posterior circulation stroke (PCS), and lacunar stroke (LS).…”

“…The proportion of patients receiving recombinant tissue plasminogen activator (rtPA) is low in our country, being 11% (104 out of 967 patients) in the on-going Indo USA National stroke registry, due to lack of trained personnel. Intraarterial and mechanical thrombolysis was given in 3.5% (34 out of 967 patients) [6] .…”