title: Eligibility assessment for intravenous thrombolytic therapy in acute ischemic stroke patients; evaluating barriers for implementation.
abstract: BACKGROUND
  Intravenous thrombolysis is an approved treatment method for patients with acute ischemic stroke (AIS) and is recommended by multiple guidelines. However, it seems that it is less frequently used in the developing countries compared to the developed countries.
  
  
  OBJECTIVE
  The purpose of this study was to estimate the percentage of patients with AIS, eligible for intravenous thrombolytic therapy, at the main referral center in Northwest Iran and to determine the main barriers for implementation of this method.
  
  
  METHODS
  Over one year, 647 patients who were admitted to the emergency department and met the Cincinnati Stroke Scale were enrolled into the study. The center to which patients were admitted, is a tertiary university hospital that has the required infrastructure for thrombolytic therapy in AIS. Factors recorded were neurological examinations and time between onset of symptoms and hospital arrival, hospital arrival and performance of brain computed tomography (CT) scanning, and hospital arrival to complete the investigations. Patients eligible for intravenous thrombolytic therapy were identified according to the American Heart Association (AHA) guidelines.
  
  
  RESULTS
  Mean time interval between hospital arrival and completion of brain CT scanning was 91 minutes (range: 20-378 minutes) and mean time from hospital arrival to completion of investigations was 150 minutes (range: 30-540 minutes). A total of 159 (31.3%) patients arrived at hospital within 3 hours of the onset of symptoms (early enough for intravenous thrombolytic therapy). However, 81.7% (130/159) of these patients missed thrombolytic therapy due to delayed performance of brain CT scanning and laboratory tests and 38.3% (61/159) had contraindications. The remaining 16 patients (10% of those who arrived within 3 hours and 3.1% of all cases) were eligible for thrombolytic therapy.
  
  
  CONCLUSIONS
  The major barriers for thrombolytic therapy for patients with AIS in this setting were delays in the provision of in-hospital services, like initial patient assessment, CT scans or laboratory studies. These results were in contrast with previous reports.
authors.affiliation: Department of Neurology, Tabriz University of Medical Sciences, Tabriz, IR Iran.
authors.forename: Hormoz
authors.initials: H
authors.lastname: Ayromlou
authors.affiliation: Department of Emergency, Tabriz University of Medical Sciences, Tabriz, IR Iran.
authors.forename: Hassan
authors.initials: H
authors.lastname: Soleimanpour
authors.affiliation: Department of Neurology, Tabriz University of Medical Sciences, Tabriz, IR Iran.
authors.forename: Mehdi
authors.initials: M
authors.lastname: Farhoudi
authors.affiliation: Department of Neurology, Tabriz University of Medical Sciences, Tabriz, IR Iran.
authors.forename: Aliakbar
authors.initials: A
authors.lastname: Taheraghdam
authors.affiliation: Department of Neurology, Tabriz University of Medical Sciences, Tabriz, IR Iran.
authors.forename: Elyar
authors.initials: E
authors.lastname: Sadeghi Hokmabadi
authors.affiliation: Department of Emergency, Tabriz University of Medical Sciences, Tabriz, IR Iran.
authors.forename: Rouzbeh
authors.initials: R
authors.lastname: Rajaei Ghafouri
authors.affiliation: Department of Neurology, Tabriz University of Medical Sciences, Tabriz, IR Iran.
authors.forename: Mehdi
authors.initials: M
authors.lastname: Najafi Nashali
authors.affiliation: Department of Neurology, Tabriz University of Medical Sciences, Tabriz, IR Iran.
authors.forename: Ehsan
authors.initials: E
authors.lastname: Sharifipour
authors.affiliation: Department of Neurology, Tabriz University of Medical Sciences, Tabriz, IR Iran.
authors.forename: Somayeh
authors.initials: S
authors.lastname: Mostafaei
authors.affiliation: Department of Neurology, Tabriz University of Medical Sciences, Tabriz, IR Iran.
authors.forename: Davar
authors.initials: D
authors.lastname: Altafi
keywords: Developing Country; Eligibility Determination; Stroke; Thrombolytic Therapy