Tissue plasminogen activator; identifying major barriers related to intravenous injection in ischemic acute cerebral infraction

Abstract

Background: According to previous publications, in patients with acute ischemic cerebral infarction, thrombolytic therapy using intravenous tissue plasminogen activator (IV-tPA) necessitates precise documentation of symptoms' onset. The aim of this study was to identify major barriers related to the IV-tPA injection in such patients. Materials and Methods: Between the year 2014-2015, patients with definitive diagnosis of acute cerebral infarction (n = 180) who attended the neurology ward located at the Isfahan Alzahra Hospital were studied. To investigate barriers related to door to IV-tPA needle time, personal reasons, and criteria for inclusion or exclusion of patients, three questionnaire forms were designed based on the Food and Drug Administration-approved indications or contraindications. Results: The mean age of males versus females was 60 versus 77.5 years (ranged 23-93 vs. 29-70 years), respectively. Out of total population, only 10.7 transferred to hospital in < 4.5 h after the onset of symptoms. Regarding to eligibility for IV-tPA, 68.9 of total population have had criteria for such treatment. Concerning to both items such as transferring to hospital in < 4.5 h after the onset of symptoms and eligibility for IV-tPA, only 6.6 of total population met the criteria for such management. There was ignorance or inattention to symptoms in 75 of population studied. There was a mean of 195.92 +/- 6.65 min (182.8-209.04 min) for door to IV-tPA needle time. Conclusion: Despite the international guidelines for IV-tPA injection within 3-4.5 h of ischemic stroke symptoms' onset, the results of this study revealed that falling time due to ignorance of symptoms, literacy, and living alone might need further attention. As a result, to decrease death and disability, educational programs related to the symptoms' onset by consultant neurologist in Isfahan/Iran seem to be advantageous.