Thrombolysis in acute ischemic stroke at a rural tertiary hospital: A case series of the first 50 patients (2016–2021)

ABSTRACT

Objectives@#To determine the outcomes for patients with acute stroke improve with early intervention in a series of the first 50 patients with acute ischemic stroke who were thrombolysed at our center. @*Methods@#National Institutes of Health Stroke Scale (NIHSS) scores were recorded by NIHSS-certified nurses-on-duty in their appropriate monitoring sheets in the chart, which was double-checked by the neurology consultant co-author on duty. Source chart entries were cross-checked with logs from the CT scan, pharmacy, and other department records before being collated by the primary author. Means and averages were used to describe the patients’ data.@*Results@#We included the first 50 patients with acute ischemic stroke, eligible for and who consented for thrombolysis. The patients had an average age of 61 years (range: 29 to 87); 32 (64%) were ≥ 60 years; 16 (32%) were male. Male gender (24/50), age ≥ 60 years old (32/50), hypertension (30/50), heart disease (6/30), smoking (7/30), and ethanol intake (9/30) were the most common risk factors. Thirty-five (70%) suffered a moderate stroke. The mean NIHSS of the 50 patients was 12.6 (range: 2 to 28). All but one received intravenous recombinant tissue plasminogen activator (IV rTPA) within 4.5 hours of onset, at a dose of 0.6 to 0.9 mg/kg. Symptomatic hemorrhagic transformation occurred in one (2%); asymptomatic hemorrhagic transformation was seen in three (6%). Fifteen of the 50 (30%) were NIHSS = 0 on discharge; another 18 (36%) showed clinical improvement compared to their status upon admission. Three patients (6%) were mRS = 0; and 30 (60%) were at least ambulatory (mRS ≤ 3) on discharge. Four patients (8%) died, one (2%) from fatal hemorrhagic transformation. Ten patients (20%) developed nosocomial pneumonia; two (4%) had catheter-related urinary tract infections More than half (52%) did not develop any in-hospital complications. The patients were admitted for a mean of 6.6 days (range < 24 hours to 20 days). The average gross bill was ₱56,041.34 (range: ₱8,729.83 to ₱182,054.08); P32,194 was the average amount our Center shouldered per patient (range: zero to ₱154,272.88); almost all were Charity Service patients who used the ₱19,600 Philippine Health Insurance Corporation case rate and the 20% senior citizen discount to help defray the costs of their hospitalization.@*Conclusion@#Stroke thrombolysis can be done in a rural tertiary hospital safely and effectively if with strong government, administration, health care workers, and community support.