Al Khathaami Ali M, Al Bdah Bayan, Tarawneh Maisoun, Alskaini Mohammed, Alotaibi Faris, Alshalan Abdulaziz, Almuhraj Mohammed, Aldaham Daham, Alotaibi Nasser
King Abdulaziz Medical City, National Guard Health Affairs, Riyadh, Saudi Arabia; College of medicine, King Saud Bin Abdul Aziz University for Health Sciences, Riyadh, Saudi Arabia; King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.
King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.
J Stroke Cerebrovasc Dis. 2020 May;29(5):104761. doi: 10.1016/j.jstrokecerebrovasdis.2020.104761. Epub 2020 Mar 12.
Recombinant tissue plasminogen activator (rt-PA, alteplase) within 4.5 hours of symptom onset decreases the rate of disability after acute ischemic stroke (AIS). Due to various reasons, alteplase remains underutilized in certain regions (∼3% in low- and middle-income countries).
We aimed to estimate the alteplase utilization rate and identify the reasons for nonuse in Saudi Arabia.
We retrospectively reviewed all patients admitted with suspected stroke in the past 24 hours to the stroke unit at King Abdulaziz Medical City, Riyadh, Saudi Arabia from February 2016 to July 2018. We estimated the alteplase utilization rate among patients with AIS who could be treated within 4.5 hours of symptoms onset (≤225 minutes, allowing 45 minutes for door to needle time). We examined potential predictors of alteplase use using multivariable logistic regression analyses. Study was approved by local IRB.
Of 1366 patients with suspected stroke, 819 (60%) had AIS. The alteplase utilization rates were 8.6% and 29% for all AIS and AIS arrived within the therapeutic window, respectively. The most common reason for no alteplase treatment was late arrival. Only 244 (29.8%) of AIS patients arrived within the time window for treatment. Among patients with sudden neurological deficit who arrived within the therapeutic time window, the most common reasons were mild neurological deficit (National Institutes of Health Stroke Scale score <5, 29.9%), stroke mimics (16.6%), and hemorrhagic stroke (8.1%).
Our study showed a comparable alteplase utilization rate with most international estimates. The low utilization rate was mainly attributed to late patient arrival. Urgent interventions are needed to improve public awareness of stroke recognition and prehospital stroke care.
症状出现后4.5小时内使用重组组织型纤溶酶原激活剂（rt-PA，阿替普酶）可降低急性缺血性卒中（AIS）后的致残率。由于各种原因，阿替普酶在某些地区的使用仍然不足（低收入和中等收入国家约为3%）。
我们旨在评估沙特阿拉伯阿替普酶的使用率，并确定未使用的原因。
我们回顾性分析了2016年2月至2018年7月期间在沙特阿拉伯利雅得阿卜杜勒阿齐兹国王医疗城卒中单元因疑似卒中入院的所有患者。我们评估了症状出现后4.5小时内（≤225分钟，允许45分钟的门到针时间）可接受治疗的AIS患者中阿替普酶的使用率。我们使用多变量逻辑回归分析检查了阿替普酶使用的潜在预测因素。该研究获得了当地机构审查委员会的批准。
在1366例疑似卒中患者中，819例（60%）患有AIS。所有AIS患者和在治疗窗内到达的AIS患者的阿替普酶使用率分别为8.6%和29%。未使用阿替普酶治疗的最常见原因是到达时间晚。只有244例（29.8%）AIS患者在治疗时间窗内到达。在治疗时间窗内到达的突发神经功能缺损患者中，最常见的原因是轻度神经功能缺损（美国国立卫生研究院卒中量表评分<5，29.9%）、类卒中（16.6%）和出血性卒中（8.1%）。
我们的研究显示阿替普酶使用率与大多数国际评估结果相当。使用率低主要归因于患者到达时间晚。需要采取紧急干预措施，以提高公众对卒中识别和院前卒中护理的认识。
