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.