Nadir Zafar Khan, Syed Ahmad Ali Hassan, Mohammad Ahad Qayyum.
Assessing the Potential of Intravenous Thrombolytic Therapy in Acute Ischemic Stroke in our Setting.
Proceeding Shaikh Zayed Postgrad Med Comp Jan ;22(1):63-7.

Background & purposes: Intravenous thrombolytic treatment with alteplase has shown to improve clinical outcomes significantly in patients with acute ischemic stroke when administered within 4.5 hours of onset of first symptom. Our study aims to determine how many stroke patients reached the Accident & Emergency of a tertiary care health facility in Lahore, Pakistan within the 4.5 hour time limit. Moreover we also set out to see how many stroke patients got imaging done (CT scan/ MRJ) with in the 4.5 hours from the onset of first symptoms at the tertiary care facility. Through this study we may be able to assess if intravenous thrombolysis has any potential of being offered to ischemic stroke patients in our setting. Methods: I 00 consecutive stroke patients presenting to our Accident & Emergency (A&E) Department over a period of 29 days (20th September 2008 to 19th October 2008) were included in this study. It is a questionnaire based cross sectional study in which convenience sampling was carried out. The questionnaire assessed the time span between onset of 1st symptom to the presentation at our A & E Department. Along with this, the questionnaire also aimed to assess the time span between onset of first symptom to the time imaging (CT scan/MRI) was done. In our study we also inquired if the patient was taken initially to a primary care facility before being referred to our facility and whether the time span between onset of first symptom and primary care physician contact was less than 4.5 hours. Type of stroke incurred was also recorded although no exclusion criteria was set out on the basis of type of stroke. Results: Among the I 00 patients questioned 9 patients reached the A & E (Accident & Emergency) Department within 4.5 hours of onset of first symptom. Of these 9 patients; 4 patients had their imaging (CT scan/MRJ) done within the 4.5 hour time limit from the appearance of the first symptom. 21 patients reached a primary care physician within the specified time limit but none of them reached the tertiary care facility within the time limit. Conclusion: When comparing our results to similar studies conducted in other countries, a larger proportion of our stroke patients did not reach the Accident & Emergency Depa11ments within the specified time period. As a result, comparatively speaki ng intravenous thrombolysis has a lesser potential of being offered to ischemic stroke patients in our setting.

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