Influence of Socio-Economic Status on Patients’ Choice of Thrombolytic Agent and It's Outcome in Acute Ischemic Stroke

Abstract

Background and Purpose: 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 role of Socio-economic status(SES) in patients’ preference of thrombolytic agent and its outcome. Methods: This prospective observational study conducted in PGIMER, a tertiary care center in India, recruited AIS patients thrombolysed between July 2017 and September 2018. We studied variables including SES, thrombolytic agent chosen and outcomes like NIHSS scores at 24 hours and at discharge; and modified Rankin Scale(mRS) after 3months. Results: 39 patients received tenecteplase and 39 patients received alteplase. 7 patients belonged to upper class, all of whom(100%) chose alteplase. 30 patients belonged to upper middle class, of whom 25(83.3%) and 5(16.7%) patients chose alteplase and tenecteplase respectively. 25 patients belonged to lower middle class in which 7(28%) and 15(72%) chose alteplase and tenecteplase respectively. 20 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 3month-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 hours post-thrombolysis(p=0.537) or at discharge(p=0.429) among different SES categories. No correlation between SES and 3month-mRS score was found(Spearman’s rho=0.101, p=0.398). Conclusions: 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. Funding: None to declare. Declaration of Interest: None to declare. Ethical Approval: Ethical clearance was obtained from institution’s Ethics committee.