Introduction-Intravenous-tPA is standard of care for acute ischemic stroke(AIS), but it is time-dependent, has contraindications, costly and requires an organized setup. The objective of this study was to assess the proportion of AIS patients receiving IV-tPA at the emergency department of a large neurology hospital and factors associated with its utilization.

Methods-It was a prospective study from May 2016 to November 2017, of AIS patients eligible for IV-tPA presenting to NIMHANS, which receives 70-100 acute neurological and 10-15 stroke patients daily, managed by 3-4 neurology residents and an on-call consultant. They were evaluated for IVT and reasons for not administering the treatment were analysed. Informed consent and ethical approval were taken.

Results-During this period 103(M:F-67:36, mean age-53.9±14.1years) patients were seen and 29(28.1%) received IVT. Forty-eight(46.6%) patients had standard contra-indication/s for IVTPA- suspected large infarct-16(15.5%), minor deficits-8(7.8%), evolved infarct-4(3.9%)-were the commonest. In remaining 55 patients, 29 underwent IVT, 24(43.6%) could not afford the drug, one(1.3%) refused and one made delay in decision. Only 42(40.8%) of the patients/relatives could identify the ictus as stroke. The mean NIHSS at presentation was 14.6±6.7. The important time parameters noted were: onset-to-presentation-145.5±60.4min, door-to-CT-28.3±19.5min, door-to-needle-90.7±39.3min and onset-to-needle-201.3±40.63min. The median mRS at 3 months in the thrombolysed and non-thrombolysed patients was same-3. Outcome was better in 7 patients thrombolysed within 3hours compared to the 20 thrombolysed between 3-4.5hours (mean mRS 1.6±1.7 and 3.5±2.1 respectively).

Conclusion-Present study highlights the various barriers for IVTPA in our hospital and tremendous scope for improvement by increasing awareness, organization of services and financial support.

UTILIZATION OF IV-TPA IN ACUTE ISCHEMIC STROKE PATIENTS PRESENTING TO EMERGENCY SERVICES OF A LARGE NEUROLOGY HOSPITAL FROM A DEVELOPING COUNTRY