Karim Nikkhah1, Abolfazl Avan2, Ali Shoeibi1, Amir Azarpazhooh3, Kavian Ghandehari1, Christian Foerch4, Gustavo Saposnik5, Payam Sasannejad1, Veda Vakili6, Parvaneh Layegh7, Mohammad Taghi Farzadfard1, Reza Bavarsad Shahripour8, Mohammad Reza Hosseini1, Mahmoud Reza Azarpazhooh9. 1. Department of Neurology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran. 2. Department of Neurology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran; Department of Medical Oncology, VU University Medical Center, Amsterdam, The Netherlands. 3. Dental Research Institute, Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada; Clinical Epidemiology Program, Institute of Health Policy, Management and Evaluation, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Toronto Health Economics and Technology Assessment Collaborative, University of Toronto, Toronto, Ontario, Canada. 4. Department of Neurology, Goethe-University, Frankfurt am Main, Germany. 5. The Division of Neurology, Department of Medicine, Stroke Outcomes Research Centre, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada. 6. Department of Community and Preventive Medicine, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran. 7. Department of Radiology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran. 8. Comprehensive Stroke Center, Department of Neurology, University of Alabama, Birmingham, Alabama. 9. Department of Neurology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran. Electronic address: azarpazhoohmr@mums.ac.ir.
Abstract
BACKGROUND: Insufficient information is available on the barriers that explain low rates of thrombolytic therapy for acute ischemic stroke (AIS) in developing countries compared with rates in developed societies. By the present study, we aimed to assess the implementation of thrombolytic therapy in the northeast of Iran to explore the gaps and hurdles against thrombolysis as the generally accepted treatment for AIS. METHODS: In a 1-year cohort study among AIS patients admitted to the second largest tertiary neurologic referral center in Iran, those who met the prespecified selection criteria were treated with intravenous recombinant tissue plasminogen activator (rtPA). RESULTS: Among 1,144 patients admitted with AIS, only 14 (1.2%) were treated with rtPA. The mean onset-to-needle and door-to-needle times were 172 and 58 minutes, respectively; 980 (85.6%) patients were initially excluded from the study because of late arrival. Additionally, 60 patients in total were omitted because of either their high age (3.7%) or passing the gold standard time limit for rtPA therapy after preliminary evaluations (1.6%), and 90 more patients (7.9%) were considered not suitable for thrombolysis because of the severity of the symptoms or the higher risk of bleeding on rtPA. CONCLUSIONS: Access to thrombolytic therapy for AIS in Iran is less than in most developed countries but comparable with other developing countries. Awareness campaigns are needed to minimize barriers and improve access to thrombolysis and specialized stroke care in Iran.
BACKGROUND: Insufficient information is available on the barriers that explain low rates of thrombolytic therapy for acute ischemic stroke (AIS) in developing countries compared with rates in developed societies. By the present study, we aimed to assess the implementation of thrombolytic therapy in the northeast of Iran to explore the gaps and hurdles against thrombolysis as the generally accepted treatment for AIS. METHODS: In a 1-year cohort study among AIS patients admitted to the second largest tertiary neurologic referral center in Iran, those who met the prespecified selection criteria were treated with intravenous recombinant tissue plasminogen activator (rtPA). RESULTS: Among 1,144 patients admitted with AIS, only 14 (1.2%) were treated with rtPA. The mean onset-to-needle and door-to-needle times were 172 and 58 minutes, respectively; 980 (85.6%) patients were initially excluded from the study because of late arrival. Additionally, 60 patients in total were omitted because of either their high age (3.7%) or passing the gold standard time limit for rtPA therapy after preliminary evaluations (1.6%), and 90 more patients (7.9%) were considered not suitable for thrombolysis because of the severity of the symptoms or the higher risk of bleeding on rtPA. CONCLUSIONS: Access to thrombolytic therapy for AIS in Iran is less than in most developed countries but comparable with other developing countries. Awareness campaigns are needed to minimize barriers and improve access to thrombolysis and specialized stroke care in Iran.
Authors: Sagar Badachi; Thomas Mathew; Arvind Prabhu; Raghunandan Nadig; Gosala R K Sarma Journal: Ann Indian Acad Neurol Date: 2015 Oct-Dec Impact factor: 1.383
Authors: Payam Sasanejad; Leila Afshar Hezarkhani; Shahram Arsang-Jang; Georgios Tsivgoulis; Abdoreza Ghoreishi; Kristian Barlinn; Jan Rahmig; Mehdi Farhoudi; Elyar Sadeghi Hokmabadi; Afshin Borhani-Haghighi; Payam Sariaslani; Athena Sharifi-Razavi; Kavian Ghandehari; Alireza Khosravi; Craig Smith; Yongchai Nilanont; Yama Akbari; Thanh N Nguyen; Anna Bersano; Nawaf Yassi; Takeshi Yoshimoto; Simona Lattanzi; Animesh Gupta; Ramin Zand; Shahram Rafie; Seyede Pourandokht Mousavian; Mohammad Reza Shahsavaripour; Shahram Amini; Saltanat U Kamenova; Aida Kondybayeva; Murat Zhanuzakov; Elizabeth M Macri; Christa O'Hana S Nobleza; Sean Ruland; Anna M Cervantes-Arslanian; Masoom J Desai; Annemarei Ranta; Amir Moghadam Ahmadi; Mahtab Rostamihosseinkhani; Razieh Foroughi; Etrat Hooshmandi; Fahimeh H Akhoundi; Ashfaq Shuaib; David S Liebeskind; James Siegler; Jose G Romano; Stephan A Mayer; Reza Bavarsad Shahripour; Babak Zamani; Amadene Woolsey; Yasaman Fazli; Khazaei Mojtaba; Christian F Isaac; Jose Biller; Mario Di Napoli; M Reza Azarpazhooh Journal: J Stroke Cerebrovasc Dis Date: 2021-09-20 Impact factor: 2.677