title: Factors influencing nonadministration of thrombolytic therapy in early arrival strokes in a university hospital in Hyderabad, India.
abstract: BACKGROUND
  It is a well-known fact that very few patients of stroke arrive at the hospital within the window period of thrombolysis. Even among those who do, not all receive thrombolytic therapy.
  
  
  OBJECTIVE
  The objectives of this study were to determine the proportion of early arrival ischemic strokes (within 6 h of stroke onset) in our hospital and to evaluate the causes of nonadministration of intravenous and/or intraarterial thrombolysis in them.
  
  
  METHODS
  Data of all early arrival acute stroke patients between January 2010 and January 2015 were included. Factors determining nonadministration of intravenous and/or intraarterial thrombolysis in early arrival strokes were analyzed.
  
  
  RESULTS
  Out of 2,593 stroke patients, only 145 (5.6%) patients presented within 6 h of stroke onset and among them 118 (81.4%) patients had ischemic stroke and 27 (18.6%) patients had hemorrhagic stroke. A total of 89/118 (75.4%) patients were thrombolyzed. The reasons for nonadministration of thrombolysis in the remaining 29 patients were analyzed, which included unavoidable factors in 8/29 patients [massive infarct (N = 4), hemorrhagic infarct (N = 1), gastrointestinal bleed (N = 1), oral anticoagulant usage with prolonged international normalized ratio (INR) (N = 1), and recent cataract surgery (N = 1)]. Avoidable factors were found for 21/29 patients, include nonaffordability (N = 7), fear of bleed (N = 4), rapidly improving symptoms (N = 4), mild stroke (N = 2), delayed neurologist referral within the hospital (N = 2), and logistic difficulty in organizing endovascular treatment (N = 2).
  
  
  CONCLUSIONS
  One-fourth of early ischemic stroke patients in our study were not thrombolyzed even though they arrived within the window period. The majority of the reasons for nonadministration of thrombolysis were potentially preventable, such as nonaffordability, intrahospital delay, and nonavailability of newer endovascular interventions.
authors: Department of Neurology, Nizam's Institute of Medical Sciences (NIMS), Hyderabad, Telangana, India.
authors: Lalitha
authors: L
authors: Pidaparthi
authors: Department of Neurology, Nizam's Institute of Medical Sciences (NIMS), Hyderabad, Telangana, India.
authors: Anitha
authors: A
authors: Kotha
authors: Department of Neurology, Nizam's Institute of Medical Sciences (NIMS), Hyderabad, Telangana, India.
authors: Venkat Reddy
authors: VR
authors: Aleti
authors: Department of Neurology, Nizam's Institute of Medical Sciences (NIMS), Hyderabad, Telangana, India.
authors: Abhijeet Kumar
authors: AK
authors: Kohat
authors: Department of Neurology, Nizam's Institute of Medical Sciences (NIMS), Hyderabad, Telangana, India.
authors: Mridula R
authors: MR
authors: Kandadai
authors: Department of Neurology, Nizam's Institute of Medical Sciences (NIMS), Hyderabad, Telangana, India.
authors: Suryaprabha
authors: S
authors: Turaga
authors: Department of Neurology, Nizam's Institute of Medical Sciences (NIMS), Hyderabad, Telangana, India.
authors: Jabeen A
authors: JA
authors: Shaik
authors: Department of Neurology, Nizam's Institute of Medical Sciences (NIMS), Hyderabad, Telangana, India.
authors: Suvarna
authors: S
authors: Alladi
authors: Department of Neurology, Nizam's Institute of Medical Sciences (NIMS), Hyderabad, Telangana, India.
authors: Meena A
authors: MA
authors: Kanikannan
authors: Department of Neurology, Nizam's Institute of Medical Sciences (NIMS), Hyderabad, Telangana, India.
authors: Borgohain
authors: B
authors: Rupam
authors: Department of Neurology, Nizam's Institute of Medical Sciences (NIMS), Hyderabad, Telangana, India.
authors: Subhash
authors: S
authors: Kaul
keywords: Avoidable factors; recombinant tissue plasminogen activator (rt-PA); stroke; thrombolysis; unavoidable factors