Acute Stroke Care and Thrombolytic Therapy Use in a Tertiary Care Center in Lebanon

الملخص EN

Background.

Thrombolytic therapy (rt-PA) is approved for ischemic stroke presenting within 4.5 hours of symptoms onset.

The rate of utilization of rt-PA is not well described in developing countries.

Objectives.

Our study examined patient characteristics and outcomes in addition to barriers to rt-PA utilization in a tertiary care center in Beirut, Lebanon.

Methods.

A retrospective chart review of all adult patients admitted to the emergency department during a one-year period (June 1st, 2009, to June 1st, 2010) with a final discharge diagnosis of ischemic stroke was completed.

Descriptive analysis was done followed by a comparison of two groups (IV rt-PA and no IV rt-PA).

Results.

During the study period, 87 patients met the inclusion criteria and thus were included in the study.

The mean age was found to be 71.9 years (SD = 11.8).

Most patients arrived by private transport (85.1%).

Weakness and loss of speech were the most common presenting signs (56.3%).

Thirty-three patients (37.9%) presented within 4.5 hours of symptom onset.

Nine patients (10.3%, 95% CI (5.5–18.5)) received rt-PA.

The two groups (rt-PA versus non rt-PA) had similar outcomes (mortality, symptomatic intracerebral hemorrhage, modified Rankin scale scores, and residual deficit at hospital discharge).

Conclusion.

In our setting, rt-PA utilization was higher than expected.

Delayed presentation was the main barrier to rt-PA administration.

Public education regarding stroke is needed to decrease time from symptoms onset to ED presentation and potentially improve outcomes further.