Thrombolysis in Stroke Patients; Problems andLimitations

Thrombolysis for stroke is being used in some developingcountries. this study was designed to evaluate the problems ofthrombolysis therapy in iran. during january-july 2008, all patientswith ischemic stroke admitted to ghaem hospital, mashhad,northeast iran, were enrolled in a prospective observationalstudy. ghaem hospital is a tertiary care hospital that includesinfrastructure for thrombolysis with tissue plasminogen activator(tpa). the stroke onset to hospital entrance time, hospitalentrance to completed investigation time, contraindications ofthrombolysis, and the capability of the patients to afford thetreatment costs by their own were recorded. of the 625 patientswith ischemic stroke, 50 (8%, 30 men, 20 women) arrived athospital within a 3-hour time window. about 44% of theseearly arrived stroke patients remained within the 3-hour timewindow to complete computed tomography and laboratorytests. about 30% of these patients were capable to pay tpa costby themselves. contraindications of thrombolysis by tpa werefound in 58% of these early arrived stroke patients. seven patients(five men, two women) were eligible for intravenousthrombolysis. the major hurdles in implementing the treatmentare the high cost of the drug and the lack of priority for triageand investigation of hyperacute stroke patients