Limitations to intravenous thrombolytic therapy in acute ischemic stroke in our settings

Background: stroke is the most common cause of disability and a leading cause of mortality worldwide. though the incidence is falling in west but is rising in asia. the burden of stroke risk factors in pakistan is enormous e.g. by 2020 pakistan will be 4th most populous country in terms of diabetic patients. aim: to determine the frequency of patients who present timely in the hospital and who can afford the thrombolytic therapy after acute ischemic stroke. methods: this cross-sectional survey was conducted in the department of emergency,shaikh zayed hospital,lahore from 3rd september 2013 to 3rd february 2014. two hundred and seventeen patients with acute ischemic stroke were enrolled for this study. an informed consent was taken from patient's relatives. patients were judged for the provision of thrombolytic therapy by focusing on the time of presentation and financial status. outcome variables i.e. frequency of timely presentation and affordability were recorded as per operational definitions. results: the mean age of the patients was 60.4±14.2 years. there were 123(56.7%) male patients and 94(43.3%) female patients. there were 16(7.4%) patients who were presented to emergency department within 4.5 hours of onset of symptoms and 201(92.6%) patients were not presented. in the distribution of patients by affordability the thrombolytic therapy,there were 35(16.1%) patients had affordability and 182(83.9%) patients had not affordability. conclusion: it is concluded from this study that very few patients cold reach emergency department within the due period to be eligible for thrombolytic therapy. in terms of affordability the situation is better but still less than the developed world. this is due to lack of awareness of thrombolytic therapy in stroke both among the patients and referring physicians,prehospital delays and lack of awareness of stroke symptoms. © 2016,lahore medical and dental college. all rights reserved.