The Challenges and Clinical Outcomes of Intravenous Recombinant Tissue Plasminogen Activator(R-TPA) Administration in a Third World Tertiary Government Hospital in the Philippines

Abstract

Background: Stroke is the second most common cause of mortality worldwide and in the Philippines. Intravenous Recombinant Tissue Plasminogen activator(R-TPA), which is provided for free in selected government hospitals, lyses cerebral arterial and venous thrombosis. It is given within a window period of 3 to 4.5 hours from stroke onset. A descriptive, retrospective and prospective analysis is needed to identify the challenges and outcomes in our institution. Objectives: To determine the clinical profile, treatment outcomes and door-to-needle time of acute ischemic stroke patients given intravenous RTPA in our institution from August 2016 to March 2017. Materials and Methods: From a total of 547 ischemic stroke patients admitted from August 2016 to March 2017, there were 7 patients who underwent Intravenous RTPA. Clinical data was collected through the hospital database. Outpatient follow up was done to assess long term outcome. Results: Patients’ mean age was 58 years, most were males. Hypertension, smoking and alcohol use were present in all patients. Average NIHSS score upon admission was 7. The average time from stroke onset to admission was 137 minutes, door-to-imaging time and ictus-to-needle time was 17 and85 minutes, respectively. Length of stay at the emergency room varied. Most patients had improved NIHSS scores and 1 had hemorrhagic conversion. Improved Modified Rankin Scale (MRS) 1 month post-RTPA was also seen, albeit not statistically significant.   Conclusion: Most patients who underwent thrombolysis had improved outcome. However, there was note of delay in drug administration due to laboratory factors and lack of monitored beds.