Reasons withholding intravenous thrombolysis for acute ischemic stroke in an Indonesian Tertiary Center

The Egyptian Journal of Neurology, Psychiatry and Neurosurgery

Research

Cynthia Putri¹  Reza Stevano¹  Yesenia Tannu¹  Jessica Herlambang¹  Aristo Pangestu¹  Rocksy Fransisca V. Situmeang² 

[1] Department of Neurology, Faculty of Medicine, Pelita Harapan University, Jl. Boulevard Jend, Sudirman No. 20, Lippo Karawaci, 15810, Tangerang, Banten, Indonesia;Department of Neurology, Faculty of Medicine, Pelita Harapan University, Jl. Boulevard Jend, Sudirman No. 20, Lippo Karawaci, 15810, Tangerang, Banten, Indonesia;Department of Neurology, Siloam Hospitals Lippo Village, Tangerang, Banten, Indonesia;

关键词: Acute ischemic stroke;    Intravenous thrombolysis;    Reperfusion therapy;    Prehospital delay;   

DOI  :  10.1186/s41983-023-00613-x

 received in 2022-04-21, accepted in 2023-01-16,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundIntravenous thrombolysis is the current therapy of choice in patients with acute ischemic stroke (AIS). While highly effective, the rate at which the procedure is employed is low. Studies evaluating the causes withholding thrombolytic treatment in developing nations remain scarce. We aim to determine the factors withholding thrombolytic treatment in AIS patients.MethodsThis is a retrospective study of AIS patients at Siloam Hospitals Lippo Village, Indonesia, in a 10-month period between April 2019 to February 2020. Patient data were collected from the medical records.ResultsOne hundred and forty-five cases of AIS were found within a 10-month period (April 2019 to February 2020). Thrombolysis was performed in 6.90% of all patients with AIS (21.28% when adjusted for eligible patients with onset ≤ 4.5 h). Prehospital delay exceeding 4.5 h was the most common cause of withholding thrombolytic treatment (68.28% of patients present above 4.5 h or with unknown onset). Among patients presenting ≤ 4.5 h, causes withholding thrombolysis include clinical improvement (35.14%), mild non-disabling symptoms (32.43%), patient/family refusal (18.92%), extensive infarction (5.41%), seizures at onset (2.7%), as well as history of acute bleeding diathesis (2.7%) and gastrointestinal bleeding (2.7%).ConclusionsPrehospital delay constitutes the primary obstacle toward receiving thrombolytic therapy for AIS, especially in developing countries. Among patients with onset below 4.5 h, other notable causes include clinical improvement, mild non-disabling symptoms, and patient/family refusal. Of note, the rate of patient/family refusal in our study was much higher compared to previous findings, which may reflect possible socio-economic, communication, or educational issues.

【 授权许可】

CC BY   
© The Author(s) 2023

【 图 表 】

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