Department of Neurology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Department of Neurology, All India Institute of Medical Sciences (AIIMS), Mangalagiri, Andhra Pradesh, India.
Neurol India. 2024 Sep 1;72(5):1003-1008. doi: 10.4103/neurol-india.ni_1187_21. Epub 2024 Oct 19.
Alteplase, a recombinant tissue-type plasminogen activator (rtPA) is the only FDA-approved thrombolytic drug in acute ischemic stroke (AIS). Tenecteplase is a modified rtPA, which is cheaper. We aimed to study influence of socioeconomic status (SES) in patients' preference of thrombolytic agent and its outcome.
This prospective observational study conducted in PGIMER, a tertiary care center in India, recruited AIS patients thrombolyzed between July 2017 and September 2018. We studied variables including SES, thrombolytic agent chosen, and outcomes like National Institutes of Health Stroke Scale (NIHSS) scores at 24-h and at discharge; and modified Rankin Scale (mRS) after 3 months.
Thirty-nine patients received tenecteplase and 39 patients received alteplase. Seven patients belonged to upper class, all of whom (100%) chose alteplase. Thirty patients belonged to upper middle class, of whom 25 (83.3%) and five (16.7%) patients chose alteplase and tenecteplase, respectively. Twenty-five patients belonged to lower middle class in which seven (28%) and 15 (72%) chose alteplase and Tenecteplase, respectively. Twenty patients were in upper lower class, of whom 4 (20%) and 16 (80%) chose alteplase and Tenecteplase, respectively. The difference in distribution of SES in tenecteplase and alteplase groups was significant (P = 0.000). Median 3 month-mRS scores were 3 and 3.5 in alteplase and tenecteplase groups, respectively (P = 0.608). There were no significant differences in NIHSS score improvement at 24 h postthrombolysis (P = 0.537) or at discharge (P = 0.429) among different SES categories. No correlation between SES and 3 month-mRS score was found (Spearman's ρ = 0.101, P = 0.398).
Majority of patients in upper and lower SES chose alteplase and Tenecteplase, respectively. However, there were no significant differences in outcomes among various SES categories.
阿替普酶，一种重组组织型纤溶酶原激活剂（rtPA），是美国食品药品监督管理局（FDA）批准用于急性缺血性脑卒中（AIS）的唯一溶栓药物。替奈普酶是一种改良的 rtPA，价格更便宜。我们旨在研究社会经济地位（SES）对患者对溶栓药物的选择及其结果的影响。
这项前瞻性观察研究在印度 PGIMER 进行，该中心为三级医疗中心，纳入了 2017 年 7 月至 2018 年 9 月期间接受溶栓治疗的 AIS 患者。我们研究了包括 SES、选择的溶栓药物以及 NIHSS 评分（24 小时和出院时）和 3 个月后的改良 Rankin 量表（mRS）等结果在内的变量。
39 例患者接受替奈普酶治疗，39 例患者接受阿替普酶治疗。7 例患者属于上层阶级，他们都（100%）选择了阿替普酶。30 例患者属于上层中产阶级，其中 25 例（83.3%）和 5 例（16.7%）患者分别选择了阿替普酶和替奈普酶。25 例患者属于中下层阶级，其中 7 例（28%）和 15 例（72%）分别选择了阿替普酶和替奈普酶。20 例患者属于上层下层阶级，其中 4 例（20%）和 16 例（80%）分别选择了阿替普酶和替奈普酶。替奈普酶和阿替普酶组的 SES 分布差异有统计学意义（P=0.000）。阿替普酶和替奈普酶组的中位 3 个月 mRS 评分分别为 3 和 3.5（P=0.608）。不同 SES 类别之间溶栓后 24 小时 NIHSS 评分改善（P=0.537）或出院时（P=0.429）无显著差异。SES 与 3 个月 mRS 评分之间无相关性（Spearman ρ=0.101，P=0.398）。
SES 较高和较低的患者分别更倾向于选择阿替普酶和替奈普酶。然而，不同 SES 类别之间的结局没有显著差异。
