Egyptian experience in increasing utilization of reperfusion therapies in acute ischemic stroke

Author:

Zakaria Magd Fouad1,Aref Hany1,Abd ElNasser Azza1,Fahmy Nagia1,Tork Mohamed Amir1,Fouad Mohamed Mahmoud1,ElBokl Ahmed1,Roushdy Tamer1,ElFaramawy Sara1,El-Shiekh Mohammad Abdullah1,Moustafa Ramez Reda1

Affiliation:

1. Department of Neurology, Faculty of Medicine, Ain Shams University, Cairo, Egypt

Abstract

Background The rate of alteplase (tPA) thrombolysis utilization in acute stroke in Egypt is <1%. We report on the causes of this low rate of reperfusion therapies and take corrective action to improve it. Methods Two prospective observational studies were conducted at Ain Shams University hospitals. The first included 269 acute stroke patients admitted to the hospital over a six-month period. Obstacles to reperfusion therapy were identified, and based on the results, a corrective action plan was implemented including making alteplase(tPA) available, training, and establishing a standardized local protocol for reperfusion therapy. A second study was then conducted that included 284 acute ischemic stroke patients over another six-month period. Results In the first study, 53/269 patients (19.7%) arrived at hospital within 4.5 h and were eligible for reperfusion therapy. Of those, seven (13.2%) received alteplase(tPA), representing 2.6% of the total ischemic stroke patients admitted. The main causes for not giving thrombolytic therapy was unavailability of alteplase(tPA) (56.5%), wrong treatment decision (17.4%), missed window while performing brain imaging (15%), and unavailability of intermediate care bed (10.9%). The second study showed that out of 284 cases admitted with acute ischemic stroke, 37 were eligible for thrombolysis and 35 received alteplase(tPA) (94.3%), representing 12.3% of the total ischemic stroke admissions. Conclusion A comprehensive action plan that centers around making the drug available and training resulted in a significant improvement of reperfusion therapy utilization in Egypt.

Publisher

SAGE Publications

Subject

Neurology

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