title: Hyperacute thrombolysis with IV rtPA of acute ischemic stroke: efficacy and safety profile of 54 patients at a tertiary referral center in a developing country.
abstract: BACKGROUND
  Given the constraints of resources, thrombolysis for acute ischemic stroke (AIS) is under evaluation in developing countries. Prothrombin time (PT), platelet count and activated partial thromboplastin time (aPTT) may not be feasible within the time window.
  
  
  OBJECTIVE
  To evaluate the safety and efficacy of thrombolysis in selected patients without the coagulation profile.
  
  
  METHODS
  Open, nonrandomized, observational study.
  
  
  METHODS
  Fifty-four stroke patients were classified using TOAST criteria (large artery atherosclerotic = 13; cardioembolic = 12; small vessel occlusion = 22; other determined etiology =three; undetermined etiology = four). The mean time to reach emergency was 2.4h (1.15-3.4), the mean door to CT, 24 min (10-47) and the door to recombinant tissue plasminogen activator (r-tPA) injection, 26.8 min (25-67). The NIHSS scores ranged from 11 to 22 (mean = 15.5 +/- 2.7). Patients with history of liver or renal disease or those on anticoagulants were excluded. The PT, aPTT and platelet count were not done. Recombinant tissue plasminogen activator was administered at a dosage of 0.9 mg/Kg.
  
  
  RESULTS
  Thirty-five patients (65%) significantly improved on NIHSS at 48 h (> or =4 points) (mean change = 10; range= 4-17). At one month, 43 (79%) improved on Barthel Index (mean change = 45%). One each developed small frontal lobe hemorrhage and recurrent stroke; one died of aspiration; and eight showed no improvement.
  
  
  CONCLUSIONS
  Hyperacute thrombolysis was found useful and safe in selected patients with AIS even without the coagulation studies.
authors.affiliation: Department of Neurology, All India Institute of Medical Sciences, New Delhi - 110 029, India. vasanthapadma123@rediffmail.com
authors.forename: M V
authors.initials: MV
authors.lastname: Padma
authors.forename: M B
authors.initials: MB
authors.lastname: Singh
authors.forename: R
authors.initials: R
authors.lastname: Bhatia
authors.forename: A
authors.initials: A
authors.lastname: Srivastava
authors.forename: M
authors.initials: M
authors.lastname: Tripathi
authors.forename: G
authors.initials: G
authors.lastname: Shukla
authors.forename: V
authors.initials: V
authors.lastname: Goyal
authors.forename: S
authors.initials: S
authors.lastname: Singh
authors.forename: K
authors.initials: K
authors.lastname: Prasad
authors.forename: M
authors.initials: M
authors.lastname: Behari
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003906:Developing Countries; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012720:Severity of Illness Index; D020521:Stroke / Q000188:drug therapy* / Q000453:epidemiology; D015912:Thrombolytic Therapy; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator