title: Temporal Trends in Intravenous Thrombolysis in Acute Ischemic Stroke: Experience from a Tertiary Care Center in India.
abstract: BACKGROUND
  Acute ischemic stroke (AIS) is a time-dependent treatable cause of morbidity and mortality. Despite the increasing stroke incidence in developing countries, parallel increasing stroke thrombolysis rates have not been documented.
  
  
  OBJECTIVE
  This study aims to determine trends in patient characteristics and rates of recombinant tissue plasminogen activator (rtPA) use in AIS patients in a tertiary care center in northern India.
  
  
  METHODS
  All AIS patients presenting within 8 hours of symptoms onset from January 2011 to December 2015 were enrolled and analyzed.
  
  
  RESULTS
  A total of 867 AIS patients presented within 8 hours of symptoms onset. Out of 593 eligible patients, 189 (31.87%) underwent intravenous thrombolysis (IVT) with rtPA within 4.5 hours of the window period. Patients (undergoing) IVT had onset-to-door times of 2 hours or less (23.81%), 2-3 hours (33.86%), and 3.0-4.5 hours (42.33%). IVT rates in 2 hours or less of symptom onset increased from 22% to 25% and IVT rates in 2-3 hours increased from 38.9% to 43.8%. Door-to-computerized tomographic time (median 27 versus 11 minutes, P = .0001) and door-to-needle time (median 83 versus 67 minutes, P = .011) improved, with a significant improvement of computerized tomography imaging time within 25 minutes of arrival (from 50% to 78.4%, P = .014). Post-IVT symptomatic hemorrhage was noted in 5 patients (2.65%). The median National Institutes of Health Stroke Scale score at presentation was 11, whereas a favorable modified Rankin Scale score (0-1) at 3 months was seen in 39.68%.
  
  
  CONCLUSIONS
  Encouraging trends in IVT over the years may be indicative of increasing community awareness of stroke and improving quality of stroke care in developing countries such as India.
authors.affiliation: Department of Neurology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India. Electronic address: dherajk@yahoo.com.
authors.forename: Dheeraj
authors.initials: D
authors.lastname: Khurana
authors.affiliation: Department of Neurology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
authors.forename: Biplab
authors.initials: B
authors.lastname: Das
authors.affiliation: Department of Neurology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
authors.forename: Ashok
authors.initials: A
authors.lastname: Kumar
authors.affiliation: Department of Neurology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
authors.forename: Amith
authors.initials: A
authors.lastname: Kumar S
authors.affiliation: Department of Radiology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
authors.forename: Niranjan
authors.initials: N
authors.lastname: Khandelwal
authors.affiliation: Department of Neurology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
authors.forename: Vivek
authors.initials: V
authors.lastname: Lal
authors.affiliation: Department of Neurology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
authors.forename: Sudesh
authors.initials: S
authors.lastname: Prabhakar
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000000981:diagnostic imaging / Q000188:drug therapy*; D002533:Cerebral Angiography / Q000639:trends; D000072226:Computed Tomography Angiography / Q000639:trends; D004185:Disability Evaluation; D004334:Drug Administration Schedule; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage*; D006801:Humans; D007194:India; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000639:trends*; D017064:Process Assessment, Health Care / Q000639:trends*; D058996:Quality Improvement; D019984:Quality Indicators, Health Care; D011994:Recombinant Proteins / Q000008:administration & dosage; D020521:Stroke / Q000000981:diagnostic imaging / Q000188:drug therapy*; D062606:Tertiary Care Centers / Q000639:trends*; D015912:Thrombolytic Therapy / Q000639:trends*; D013997:Time Factors; D061665:Time-to-Treatment / Q000639:trends; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage*; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents; D011994:Recombinant Proteins; D010959:Tissue Plasminogen Activator
keywords: Stroke; developing countries; intravenous thrombolysis; rtPA; trends