Kulkarni Girish Baburao, Mahajan Niranjan Prakash, Aravinda H R
Department of Neurology, NIMHANS, Bengaluru, India.
Department of Neurology, Narayana Health City, Bengaluru, Karnataka, India.
Neurol India. 2022 May-Jun;70(3):972-977. doi: 10.4103/0028-3886.349615.
Intravenous thrombolysis (IVT) is an effective treatment for carefully selected acute ischemic stroke (AIS) patients. However, very few eligible candidates access it in time around the world, including India, due to multiple barriers.
We explored the barriers to IVT in patients of AIS presenting within a 4.5-h window period in our hospital.
This was a prospective study of AIS patients presenting in <4.5 h of symptom-onset, aged >18 years at the Neuro-casualty, Department of Neurology, from May 2016 to November 2017. Assessment of barriers to intravenous thrombolysis was done, and an attempt to delineate the reasons for the pre-hospital and the in-hospital delay was made.
A total of 103 (M:F: 67:36) patients aged between 18 and 80 years, were recruited, with 28 (27.2%) patients aged <45 years. Among them, 29 (28.2%) were thrombolysed. The major reasons for the pre-hospital delay were ignorance about the need for stroke center consultation- 94 (90.3%), consultation elsewhere before the presentation- 84 (81.5%), and non-availability of an ambulance at referring hospitals- 50 (59.52% out of 84). Sixty-four patients (62.1%) could not name any symptoms of stroke, 84 (83.5%) could not name any risk factor, and only 4 (3.9%) were aware of IVT. Key in-hospital barriers were crowded emergency- 80 (77.7%), financial constraints- 79 (76.7%), and delay in CT scan- 62 (61.4%). Delay in arriving at a consensus for IVT by the patient/relative and the treating neurologist, was noted in 24 (43.6%) of the 55 eligible.
Many eligible patients remain deprived of thrombolysis due to lack of awareness, financial constraints, and organizational elements, which should be addressed to improve IVT rates.
静脉溶栓（IVT）是对经过精心挑选的急性缺血性卒中（AIS）患者的一种有效治疗方法。然而，由于多种障碍，包括印度在内，全球范围内很少有符合条件的患者能及时接受该治疗。
我们探讨了在我院4.5小时时间窗内就诊的AIS患者接受IVT的障碍。
这是一项对2016年5月至2017年11月期间在神经科急诊就诊、症状发作时间<4.5小时、年龄>18岁的AIS患者进行的前瞻性研究。对静脉溶栓的障碍进行了评估，并试图明确院前和院内延误的原因。
共招募了103例年龄在18至80岁之间的患者（男:女=67:36），其中28例（27.2%）年龄<45岁。其中，29例（28.2%）接受了溶栓治疗。院前延误的主要原因是对卒中中心会诊需求的无知——94例（90.3%），就诊前在其他地方会诊——84例（81.5%），转诊医院没有救护车——50例（在84例中占59.52%）。64例患者（62.1%）说不出任何卒中症状，84例（83.5%）说不出任何危险因素，只有4例（3.9%）知晓IVT。主要的院内障碍是急诊拥挤——80例（77.7%），经济限制——79例（76.7%），以及CT扫描延迟——62例（61.4%）。在55例符合条件的患者中，有24例（43.6%）患者/家属与主治神经科医生在达成IVT共识方面出现延迟。
由于缺乏认识、经济限制和组织因素，许多符合条件的患者无法接受溶栓治疗，应解决这些问题以提高IVT治疗率。
