PND83 ACCESS TO INTRAVENOUS TISSUE-LIKE PLASMINOGEN ACTIVATOR (IV TPA) THERAPY AND MECHANICAL THROMBECTOMY (MT) FOR PATIENTS WITH ACUTE ISCHEMIC STROKE IN HUNGARY

Abstract

Since 2002, IV tPA has been approved in Europe for use in acute stroke, which in 2015 was complemented by MT. These acute stroke treatments have significantly improved patient outcomes. However, in ischemic stroke, access to care requires adequate management of patient pathways. The objective of our study was to assess the extent by which acute ischemic stroke patients access IV tPA and MT treatment options in Hungary. Data was retrieved from the Pulvita Healthcare Data Warehouse operated by National Healthcare Services Center (AEEK) and a dedicated acute ischemic stroke registry, in which data was provided by three thrombectomy centers (University of Pécs, University of Debrecen and University of Szeged). Estimations were made regarding the actual number of acute ischemic stroke patients, number and ratio of patients treated with IV tPA or MT. Between the 1st and 3rd quarter of 2018, 2,426 patients (8.3% of all ischemic strokes) were treated with iv-tPA and/or MT in Hungary. Based on the data of three thrombectomy centres, 21.2% of the patients received MT alone, 75.0% received IV tPA alone, and 3.8% received both treatments. 15.3% of all MT were performed after IV tPA. 25.3% of all MTs were performed within 4.5 hours without IV tPA, while 57.8% were between 4.5 and 6 hours and 1.4% beyond 6 hours of the onset of stroke event. Our study shows that the access to and delivery of IV tPA and MT are relatively low in Hungary, especially when compared to Western European countries, where the proportion of ischaemic patients receiving IV tPA was 18% in Austria in 2011, and 16.7% in France in 2014–2015. These findings indicate a major opportunity for optimizing the stroke care pathway according to the most recent treatments and reduce ischaemic stroke mortality.