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J Stroke Cerebrovasc Dis. 2015 Feb;24(2):408-15. doi: 10.1016/j.jstrokecerebrovasdis.2014.09.012. Epub 2014 Dec 12.

Gaps and hurdles deter against following stroke guidelines for thrombolytic therapy in Iran: exploring the problem.

Author information

1
Department of Neurology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
2
Department of Neurology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran; Department of Medical Oncology, VU University Medical Center, Amsterdam, The Netherlands.
3
Dental Research Institute, Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada; Clinical Epidemiology Program, Institute of Health Policy, Management and Evaluation, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Toronto Health Economics and Technology Assessment Collaborative, University of Toronto, Toronto, Ontario, Canada.
4
Department of Neurology, Goethe-University, Frankfurt am Main, Germany.
5
The Division of Neurology, Department of Medicine, Stroke Outcomes Research Centre, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
6
Department of Community and Preventive Medicine, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
7
Department of Radiology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
8
Comprehensive Stroke Center, Department of Neurology, University of Alabama, Birmingham, Alabama.
9
Department of Neurology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran. Electronic address: azarpazhoohmr@mums.ac.ir.

Abstract

BACKGROUND:

Insufficient information is available on the barriers that explain low rates of thrombolytic therapy for acute ischemic stroke (AIS) in developing countries compared with rates in developed societies. By the present study, we aimed to assess the implementation of thrombolytic therapy in the northeast of Iran to explore the gaps and hurdles against thrombolysis as the generally accepted treatment for AIS.

METHODS:

In a 1-year cohort study among AIS patients admitted to the second largest tertiary neurologic referral center in Iran, those who met the prespecified selection criteria were treated with intravenous recombinant tissue plasminogen activator (rtPA).

RESULTS:

Among 1,144 patients admitted with AIS, only 14 (1.2%) were treated with rtPA. The mean onset-to-needle and door-to-needle times were 172 and 58 minutes, respectively; 980 (85.6%) patients were initially excluded from the study because of late arrival. Additionally, 60 patients in total were omitted because of either their high age (3.7%) or passing the gold standard time limit for rtPA therapy after preliminary evaluations (1.6%), and 90 more patients (7.9%) were considered not suitable for thrombolysis because of the severity of the symptoms or the higher risk of bleeding on rtPA.

CONCLUSIONS:

Access to thrombolytic therapy for AIS in Iran is less than in most developed countries but comparable with other developing countries. Awareness campaigns are needed to minimize barriers and improve access to thrombolysis and specialized stroke care in Iran.

KEYWORDS:

Stroke; cohort study; developing countries; stroke facilities; thrombolysis; treatment

[Indexed for MEDLINE]

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