Outcomes of stroke patients undergoing thrombolysis in Sri Lanka; an observational prospective study from a low-middle income country

H M M T B Herath,Sunethra Senanayake,Sathyajith Buddhika Ambawatte,Bimsara Senanayake,Arjuna Fernando,Chaturaka Rodrigo,A M B D Alahakoon

doi:10.1186/s12883-021-02475-3

H M M T B Herath, Sunethra Senanayake + Show 5 more

Open Access

https://doi.org/10.1186/s12883-021-02475-3

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Journal: BMC Neurology	Publication Date: Nov 9, 2021
Citations: 5	License type: open-access

Affiliation: National Hospital of Sri Lanka, UNSW Sydney

Abstract

BackgroundStroke related deaths are relatively higher in low- and middle-income countries where only a fraction of eligible patients undergo thrombolysis. There is also limited evidence on post-thrombolysis outcomes of patients from Asian countries in these income bands.MethodsThis is a single center prospective observational study of a patient cohort with acute ischaemic stroke, undergoing thrombolysis with alteplase (low and standard dose), over a 24-month period in 2019/2020. Modified Rankin scale (mRS) for dependency at 3 months (primary outcome), duration of hospital stay, incidence of symptomatic intracranial haemorrhages and all-cause mortality at 3 months (secondary outcomes) were recorded. Demographic, clinical and treatment related factors associated with these outcomes were explored.ResultsEighty-nine patients (males – 61, 69%, mean age: 60 years ±12.18) were recruited. Time from symptom onset to reperfusion was 174 min ± 56.50. Fifty-one patients were independent according to mRS, 11 (12.4%) patients died, and 11 (12.5%) developed symptomatic intracranial haemorrhages by 3 months. Functional independence at 3 months was independently associated with National Institutes of Health Stroke Scale (NIHSS) on admission (p < 0.05). Thrombolysis with low dose alteplase did not lead to better or worse outcomes compared to standard dose.ConclusionsOn admission NIHSS is predictive of functional independence at 3 months post-thrombolysis. Low dose alteplase may be as efficacious as standard dose alteplase with associated cost savings, but this needs to be confirmed by a prospective clinical trial for the Sri Lankan population.

Highlights

Stroke related deaths are relatively higher in low- and middle-income countries where only a fraction of eligible patients undergo thrombolysis
Thrombolysis with intravenous alteplase is one of the most important therapies in acute stroke management, but remains out of reach for many eligible candidates in lower – middle income countries [2, 3], partly due to unavailability of the drug, public unawareness, and due to lack of infrastructure which prevents patients reaching hospitals within the specified time window [2]
The primary aim of this study is to describe the outcomes of a cohort of patients that underwent thrombolytic therapy at the National Hospital of Sri Lanka over a 24-month period

Summary

Introduction

Stroke related deaths are relatively higher in low- and middle-income countries where only a fraction of eligible patients undergo thrombolysis. Age standardized stroke related disability adjusted life years lost (DALYs) has been declining in countries across all income bands, probably reflecting advances in stroke care and therapy in the last 15 years, but there is still a huge discrepancy between high – income countries and others [1]. Overall, these numbers reflect the global inequality in resource distribution leading. Clinical research data on thrombolysis for ischaemic stroke from low-middleincome countries are limited, compared to high income countries [5]

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