Thrombolysis in Stroke Patients; Problems and Limitations

Thrombolysis for stroke is being used in some developing countries. This study was designed to evaluate the problems of thrombolysis therapy in Iran. During January-July 2008, all patients with ischemic stroke admitted to Ghaem Hospital, Mashhad, northeast Iran, were enrolled in a prospective observational study. Ghaem Hospital is a tertiary care hospital that includes infrastructure for thrombolysis with tissue plasminogen activator (tPA). The stroke onset to hospital entrance time, hospital entrance to completed investigation time, contraindications of thrombolysis, and the capability of the patients to afford the treatment costs by their own were recorded. Of the 625 patients with ischemic stroke, 50 (8%, 30 men, 20 women) arrived at hospital within a 3-hour time window. About 44% of these early arrived stroke patients remained within the 3-hour time window to complete computed tomography and laboratory tests. About 30% of these patients were capable to pay tPA cost by themselves. Contraindications of thrombolysis by tPA were found in 58% of these early arrived stroke patients. Seven patients (five men, two women) were eligible for intravenous thrombolysis. The major hurdles in implementing the treatment are the high cost of the drug and the lack of priority for triage and investigation of hyperacute stroke patients.