Outcomes of Stroke Patients Undergoing Thrombolysis in Sri Lanka; an Observational Prospective Study From a Low-middle Income Country

Abstract

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. Demographic, clinical (including scoring systems for functional impairment) and imaging data of all patients were recorded prior to thrombolysis, within 24-hours post-thrombolysis and at 3-months follow up. Incidence of symptomatic intracranial haemorrhages and all-cause mortality by 3 months was also recorded.ResultsEighty-nine patients (males – 61, 69%, mean age: 60 years ± 12.18) were recruited. Time from symptom onset to reperfusion was 174 minutes ± 56.50. Ten (11%) patients died and 19 (21%) developed symptomatic intracranial haemorrhages (sICH) by 3 months. Functional independence at 3 months (measured by Barthel index, National Institutes of Health Stroke Score – NIHSS, or modified Rankin scale - mRS) was independently associated with NIHSS on admission (p<0.05). Thrombolysis with low dose alteplase was associated with better NIHSS or mRS scores (p<0.05) at 3 months compared to standard dose.ConclusionsOn admission NIHSS is predictive of functional independence at 3 months and reducing the time from symptom onset to thrombolysis, may further improve outcomes. The preliminary observations on low dose alteplase efficacy must be confirmed by a randomized controlled trial in the local population.