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Neurology India, Vol. 52, No. 1, January-March, 2004, pp. 126-127 Letter To Editor Feasibility of acute thrombolytic therapy for stroke: Comments Pandian JD Department of Neurology, Christian Medical College, Ludhiana, Punjab - 141008 Code Number: ni04038 Sir, I read with interest the article by Nandigam et al.[1] The authors discuss the feasibility of thrombolytic therapy from a rural catchments area. There are many factors, which delay the hospital admission in patients with acute stroke, such as patients or relatives unable to recognize the symptoms, mode of transport and a well-organized emergency room services. Availability of 24 hours CT Scan services is one the most important necessity for thrombolysis in acute ischemic stroke. I would like to know about the number of patients who arrived within 90 minutes of stroke onset, since thrombolysis can be effectively given in this group of patients, taking into account the time for evaluation as well as the infusion period. In our "Stroke Unit" a total of 489 stroke patients were seen over the last 24 months. Seventy-two of them (14.7%) presented within 3 hours of window period. Thirty-five (48.6%) patients presented within 1 hour, 19(26.3%) within 1-2 hours and 18(25%) between 2-3 hours of onset of stroke. About 36(50%) patients had ischemic stroke, 29(40.2%) had intracerebral hemorrhage and 7(9.7%) subjects presented with transient ischemic attack. Only 5(7%) patients received rTpA after complete evaluation. Thrombolysis couldn′t be given in 10% of the subjects due to non-affordability of the drug. Even in an urban industrial city like Ludhiana only 7% of the patients who fulfilled the criteria received rTpA. We also studied the factors causing delay in hospital admission. The factors associated with an early arrival in Univariate analysis were: <10kms distance from the hospital (p<0.005), presence of a bystander (p<0.005), arriving directly to stroke center (p<0.03), possession of personal car (p<0.001), large vessel ischemic stroke (p<0.005) and transient ischemic attack (p<0.003). In step wise multivariate logistic regression model, <10kms travel distance (p<0.002) was the only factor contributing to an early arrival to the hospital. In our country with inadequate transport facilities to the hospital we should concentrate on educating the public, who are in close vicinity to the hospital (<10kms). Only this group of people can reach the hospital within the window period. As Nandigam et al[1] rightly pointed out that the General practitioners and Physicians should be made aware of the facility. Most of the patients who had reached our hospital after 3 hours were sent for imaging studies to other private centers for various commercial reasons, which leads to loss of precious time. References
Copyright 2004 - Neurology India |
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