Assessment of eligibility for thrombolysis in acute ischaemic stroke patients in Morocco

Abstract

Introduction: intravenous thrombolysis with recombinant tissue plasminogen activator (rTPA) is an approved treatment for acute ischaemic stroke (AIS). However, its use remains low. We aimed to assess the eligibility of thrombolysis for our patients with AIS before implementing this treatment method in our teaching hospital.

Methods: we conducted a prospective cross-sectional study in the emergency department of Casablanca University Hospital. We included every patient admitted for a stroke-related symptom. Delays between symptom-onset and admission and delays regarding the in-hospital evaluation of patients were recorded. Patients eligible for intravenous thrombolytic therapy were identified according to American Heart Association guidelines.

Results: in all, 463 patients were included. Only 8.42% of patients were eligible for thrombolysis; 74% of patients were ineligible because of an onset-to-thrombolysis delay longer than 4.5 hours. Mean onset-to-thrombolysis time was 27.2 hours. Patients were admitted with a mean delay of 24.9 hours. The in-hospital evaluation, from admission to computerized tomography (CT) interpretation, averaged 2.3 hours in length.

Conclusion: the percentage of patients eligible for thrombolysis remains very low in our structure. The majority would not have benefitted from the therapy because of an extra hospital delay far exceeding the recommended therapeutic window. To shorten our delays and increase the number of patients benefiting from thrombolysis, we must implement strategies aiming to improve the recognition, evaluation and management of patients from the general public to the neurovascular unit.