Patterns and outcomes of stroke thrombolysis in a tertiary care hospital in North East India

Abstract

Introduction: Intravenous thrombolysis with alteplase (tissue plasminogen activator -tPA) has been approved as the standard of care for the treatment of acute ischemic stroke (AIS) since 1995. Although there have been sporadic reports of hyperacute stroke thrombolysis coming from North-East India, a well-structured study from this resource poor area is lacking in this regard. Objective:To study the efficacy and safety of intravenous thrombolysis with tPA in AIS. Materials and methods: All patients of acute Ischemic stroke who were thrombolysed using the 4.5 hour window period, between Dec 2017 to April 2021 were enrolled and studied. We analyzed differences in age, gender, time from onset to start IVT, door to needle time (DNT), pretreatment NIHSS score, postoperative NIHSS score, and so on. They were followed up for a period of 3 months for the determination of outcome. The death rate at 90 days and incidence of SICH were used for assessment of safety. Results:A total of 30 patients were thrombolysed. 37% of patients were thrombolysed during the covid-19 pandemic. Hypertension was the most common risk factor. The mean Door to needle(DTN) time was 74.1 minutes with the shortest being 25 minutes. The mean NIHSS score at the point of hospitalization was 12.42 and after 24 hours was 9.27. In 57.69% of patients, the primary outcome (≥4 increment in NIHSS score) was achieved. 14.8% of patients suffered from adverse outcomes (death and SICH). Conclusion: This study re-affirms the safety and efficacy of IV tPA for hyperacute stroke thrombolysis in our set-up.