Neurology India, Vol. 52, No. 4, October-December, 2004, pp. 519
Letter To Editor
Time and cost: Are they the only contributors to poor rate of stroke thrombolysis
Nandigam Kaveer, Narayan SunilK
Department of Neurology, 428, Lister House, Jawaharlal Institute of Post Graduate Medical Education and Research, Pondicherry
Code Number: ni04181
The study published by Dr. Pandian in an urban industrial city like Ludhiana, showed that only 7% of patients reaching within 3 hours received rTPA after complete evaluation and thrombolysis couldn′t be given in 10% of the subjects due to non-affordability of the drug, which shows that in rest of about 35% of ischemic stroke patients, excluding hemorrhages and TIAs, thrombolysis was not done due factors beyond cost and time. In our study, of twenty patients presenting within three hours, nine (45%) patients presented within one hour, two (10%) within 1-2 hours and nine (45%) between 2-3 hours of the onset of the stroke. Of them, thirteen (65%) were ischemic strokes and though seven being eligible, none received thrombolysis. We found it interesting that none of the patients were explained the available option of thrombolytic therapy and the cost involved. This to some extent, could be due to reluctance on part of the physicians to provide thrombolysis to stroke patients though we did not use a questionnaire to analyze the physician factors. It appears that the poor rate of thrombolytic therapy in our country cannot be entirely blamed on the part of patients for their late presentation and non-affordability of rTPA. The onset of stroke is such a catastrophic event in majority of cases, with paralysis of limbs, inability to speak or loss of conscious, that it will create a panic to the patients and their relatives, and they will be immediately rushed to the nearest available health facility. Hence, in an urban or more importantly in a rural setup, the primary care physician must explain to the patient′s relatives, the available treatment options, costs involved and the importance of time window, and refer them to an appropriate referral center which provides thrombolytic therapy. Even for the patients from rural areas, despite lack of adequate public transport facilities and ambulance services, a sizable number reached the referral center with the help of private transportation, which is reflected by as many as 20 (31%) of 64 rural patients reaching within 3 hours. Training programmes in the form of workshops and CME programmes need to be provided for the primary care physicians involved in the care of stroke patients, to encourage them to initiate thrombolysis in more number of strokes. The role of physicians is of paramount importance, in rendering thrombolytic therapy, in this new era of economic development, where more number of patients are able to reach the hospital within the time window and are able to afford the drug.
Copyright 2004 - Neurology India