Barriers to Receiving Tissue Plasminogen Activator in Patients with Ischemic Stroke

authors:

avatar Monirsadat Mirzadeh ORCID 1 , avatar Hosein Mozhdehipanah 2 , avatar Ali Emami ORCID 3 , avatar Niloofar Motamed 4 , *

Metabolic Diseases Research Center, Research Institute for Prevention of Non-Communicable Diseases, Qazvin University of Medical Sciences, Qazvin, Iran.
Department of Neurology, Bou-Ali Sina Hospital, Qazvin University of Medical Sciences, Qazvin, Iran.
Student Research Committee, Qazvin University of Medical Sciences, Qazvin, Iran.
Persian Gulf Nuclear Medicine Research Center, The Persian Gulf Biomedical Research Center, Bushehr University of Medical Sciences, Bushehr, Iran.
Journal of Inflammatory Diseases: Vol.25, issue 1; 11-18
article type: issue_documents_importer

how to cite: Mirzadeh M, Mozhdehipanah H, Emami A, Motamed N. Barriers to Receiving Tissue Plasminogen Activator in Patients with Ischemic Stroke. J Inflamm Dis. 2021;25(1):e156260. 

Abstract

Background: Cerebrovascular diseases are the second common cause of mortality worldwide. The onset of reperfusion in the first 3-4.5 hours is a predictive factor of treatment. Objective: The present study investigated barriers to receiving tissue plasminogen activator in patients with ischemic stroke. Methods: This cross-sectional study examined 191 patients with first-ever stroke referring to the emergency department of the Persian Gulf Martyrs Hospital of Bushehr City, Iran, in 2016. One checklist was completed which included demographic data, history of diseases, knowledge of stroke symptoms, and intervals regarding the onset of symptoms to informing emergency, informing emergency on arrival at the emergency department of the hospital, and making the diagnosis for the patients. The obtained data were analyzed in SPSS v. 19. Results: Mean±SD age of the patients was 65.92±12.48 years. The majority of patients under investigation (55.5%) were female, 63.4% were married, 56% were illiterate and 72.3% resided in other districts of Bushehr province. Mean duration between onset of symptoms and arrival at emergency department, onset of symptoms and call the emergency service, time of arrival at emergency department to perform brain Computer Tomography (CT) scan and also to be counseled by a neurologist were 699.66, 195.51, 45.11 and 423.62 minutes, respectively. Finally 14.6 percent of patients were qualified to be treated with tPA. Conclusion: The main barrier to timely therapy is a delay in golden time. Therefore, public education to promote public awareness could be of great benefit in reducing the referral delay time.

References

  • 1.

    Felling RJ, Sun LR, Maxwell EC, Goldenberg N, Bernard T. Pediatric arterial ischemic stroke: Epidemiology, risk factors, and management. Blood Cells Mol Dis. 2017; 67:23-33. [DOI:10.1016/j.bcmd.2017.03.003] [PMID].

  • 2.

    Guzik A, Bushnell Ch. Stroke epidemiology and risk factor management. Continuum. 2017; 23(1), Cerebrovascular Disease: 15-39. [DOI:10.1212/CON.0000000000000416] [PMID].

  • 3.

    Venketasubramanian N, Yoon BW, Pandian J, Navarro JC. Stroke epidemiology in South, East, and South-East Asia: A review. J Stroke. 2017; 19(3):286-94. [DOI:10.5853/jos.2017.00234] [PMID] [PMCID].

  • 4.

    Aked J, Delavaran H, Norrving B, Lindgren A. Temporal trends of stroke epidemiology in Southern Sweden: A population-based study on stroke incidence and early case-fatality. Neuroepidemiology. 2018; 50(3-4):174-82.[DOI:10.1159/000487948] [PMID].

  • 5.

    Favate AS, Younger DS. Epidemiology of ischemic stroke. Neurol Clin. 2016; 34(4):967-80. [DOI:10.1016/j.ncl.2016.06.013] [PMID].

  • 6.

    Hasan TF, Rabinstein AA, Middlebrooks EH, Haranhalli N, Silliman SL, Meschia JF, et al., editors. Diagnosis and management of acute ischemic stroke. Mayo Clin Proc. 2018; 93(4):523-38. [DOI:10.1016/j.mayocp.2018.02.013] [PMID].

  • 7.

    Arch AE, Weisman DC, Coca S, Nystrom KV, Wira III CR, Schindler JL. Missed ischemic stroke diagnosis in the emergency department by emergency medicine and neurology services. Stroke. 2016; 47(3):668-73. [DOI:10.1161/STROKEAHA.115.010613] [PMID].

  • 8.

    Matys T, Pawlak R, Matys E, Pavlides C, McEwen BS, Strickland S. Tissue plasminogen activator promotes the effects of corticotropin-releasing factor on the amygdala and anxietylike behavior. Proc Natl Acad Sci U S A. 2004; 101(46):16345-50. [DOI:10.1073/pnas.0407355101] [PMID] [PMCID].

  • 9.

    OBrien EC, Xian Y, Xu H, Wu J, Saver JL, Smith EE, et al. Hospital variation in home-time after acute ischemic stroke: Insights from the PROSPER study (Patient-Centered Research into Outcomes Stroke Patients Prefer and Effectiveness Research). Stroke. 2016; 47(10):2627-33. [DOI:10.1161/STROKEAHA.116.013563] [PMID].

  • 10.

    Alawieh A, Pierce AK, Vargas J, Turk AS, Turner RD, Chaudry MI, et al. The golden 35 min of stroke intervention with ADAPT: Effect of thrombectomy procedural time in acute ischemic stroke on outcome. J Neurointerv Surg. 2018; 10(3):213-20. [DOI:10.1136/neurintsurg-2017-013040] [PMID].

  • 11.

    Hargis M, Shah JN, Mazabob J, Rao CV, Suarez JI, Bershad EM. Barriers to administering intravenous tissue Plasminogen Activator (tPA) for acute ischemic stroke in the emergency department: A cross-sectional survey of stroke centers. Clin Neurol Neurosurg. 2015; 135:79-84. [DOI:10.1016/j.clineuro.2015.04.027] [PMID].

  • 12.

    Hatamabadi HR, Mansourifar H, Asarzadegan F, Shojaee M. Barriers to on time delivery of thrombolytic therapy for patients with acute stroke. J Mazandaran Univ Med Sci. 2013; 23(102):107-10. [In Persian] http://jmums.mazums.ac.ir/article-1-2397-en.html.

  • 13.

    Daneshfard B, Izadi S, Shariat A, Toudaji MA, Beyzavi Z, Niknam L. Epidemiology of stroke in Shiraz, Iran. Iran J Neurol. 2015; 14(3):158-63. [PMID] [PMCID].

  • 14.

    Suwanwela NC, Poungvarin N, Asian Stroke Advisory Panel. Stroke burden and stroke care system in Asia. Neurol India. 2016; 64(7):46-51. [DOI:10.4103/0028-3886.178042] [PMID].

  • 15.

    Ostovar A, Nabipour I, Larijani B, Heshmat R, Darabi H, Vahdat K, et al. Bushehr Elderly Health (BEH) Programme, phase I (cardiovascular system). BMJ Open. 2015; 5(12):e009597.[DOI:10.1136/bmjopen-2015-009597] [PMID] [PMCID].

  • 16.

    El Tallawy HN, Farghaly WM, Badry R, Hamdy NA, Shehata GA, Rageh TA, et al. Epidemiology and clinical presentation of stroke in Upper Egypt (desert area). Neuropsychiatr Dis Treat. 2015; 11:2177-83. [DOI:10.2147/NDT.S87381][PMID] [PMCID].

  • 17.

    Azarpazhooh MR, Etemadi MM, Donnan GA, Mokhber N, Majdi MR, Ghayour-Mobarhan M, et al. Excessive incidence of stroke in Iran: Evidence from the Mashhad Stroke Incidence Study (MSIS), a population-based study of stroke in the Middle East. Stroke. 2010; 41(1):e3-10. [DOI:10.1161/STROKEAHA.109.559708] [PMID].

  • 18.

    Ayromlou H, Soleimanpour H, Farhoudi M, Taheraghdam AA, Sadeghi Hokmabadi E, Rajaei Ghafouri R, et al. Eligibility assessment for intravenous thrombolytic therapy in acute ischemic stroke patients; evaluating barriers for implementation. Iran Red Crescent Med J. 2014; 16(5):e11284.[DOI:10.5812/ircmj.11284] [PMID] [PMCID].

  • 19.

    Aboutalebi Sh, Moghadasian M, Moradi A, Pazoki R. The knowledge assessment of stroke in over age 25 years old habitants of Bushehr port 2005. Iran South Med J. 2006; 9(1):59-65.[In Persian] http://ismj.bpums.ac.ir/article-1-47-en.html.

  • 20.

    Mojdehipanah H, Yazdi Z, Sayyad Nasiri M, Azizlo Z. Barriers to delivery of tissue plasminogen activator for patients with acute ischemic stroke. Feyz. 2015; 19(2):169-76. [In Persian]http://feyz.kaums.ac.ir/article-1-2625-en.html.

  • 21.

    American Heart Association. Target: Stroke - When seconds count [Internet]. 2010 [Updated 2010]. Available from: https://www.heart.org/en/professional/quality-improvement/target-stroke/learn-more-about-target-stroke.

  • 22.

    Dhaliwal J, Ferrigno B, Abiola O, Moskalik A, Sposito J, Wolansky LJ, et al. Hospital-based intervention to reduce tPA administration time. Interdiscip Neurosurg. 2019; 15:15-8.[DOI:10.1016/j.inat.2018.09.005]##.