challenges and outcomes of thrombolytic therapy in acute ischemic stroke: the iranian perspective

Background: acute ischemic stroke (ais) is a leading cause of mortality and long-term disability worldwide. in iran, ais tends to occur nearly a decade earlier than in developed nations, presenting unique challenges. intravenous recombinant tissue plasminogen activator (iv-rtpa) is an effective thrombolytic therapy for ais, but various factors limit its utilization.objectives: this study aimed to identify the barriers to the administration of iv-rtpa in ais patients at shahid beheshti hospital in qom, iran. methods: a cross-sectional descriptive-analytical study was conducted on ais patients admitted between november 2021 and september 2022. a total of 322 patients were screened, and 178 met the inclusion criteria. data on demographic characteristics, stroke severity (nihss score), comorbidities, onset-to-door time, and reasons for not receiving iv-rtpa were analyzed using spss version 22. results: of the 178 patients, 87 (48.9%) received iv-rtpa, while 91 (51.1%) did not. the primary reasons for withholding thrombolysis were clinical improvement (37.4%), late hospital arrival beyond 4.5 hours (24.2%), lack of consent (20.9%), the physician's conservative approach (11%), and mild progression of stroke symptoms (6.6%). a significant correlation was found between nihss score and reasons for non-receipt of therapy (p < 0.001). patients with a prior stroke history were more likely to experience delays due to a physician’s conservative approach (28.6% vs. 5.7%, p < 0.01). barriers to thrombolysis were also associated with lower education levels and a lack of public awareness about stroke symptoms. conclusions: delayed hospital admission and lack of consent were the leading barriers to iv-rtpa administration. public awareness campaigns emphasizing the urgency of recognizing stroke symptoms and seeking timely medical care are crucial to improving thrombolysis rates and reducing ais-related disabilities in iran.