Abstract W MP25: Intravenous Thrombolysis in India: The Indo-US Stroke Project
Background: There is limited information concerning stroke thrombolysis in developing countries like India. We investigated the frequency, barriers and outcomes after thrombolysis in 5 high-volume hospitals across India.
Methods: The Indo-US Stroke Registry and Infrastructure Development Project, jointly funded by NINDS and the Indian Department of Biotechnology, currently include 5 geographically diverse centers in North and South India and one in Boston, USA. Trained MD co-investigators and research coordinators prospectively collect data on consecutive adult patients with imaging-confirmed ischemic stroke <2 weeks after symptom onset. Data is entered into a central web-based electronic database.
Results: From Nov-2012 to July-2014, 1944 patients were enrolled. Two hundred and eighty six were eligible for tPA. A total of 215 patients (11% of the total cohort and 75% of tPA-eligible patients) received thrombolysis including 139 of 188 patients who arrived <3h after onset and 76 of 98 who arrived between 3-4.5 h. Mean age was 59±15 years (range 48-69 years) and 68% were male. Stroke risk factors included hypertension (75%), diabetes (48%), hyperlipidemia (18%), coronary artery disease (27%), rheumatic heart disease (12%), atrial fibrillation (9%) and myocardial infarction (10%).The median NIHSS score was 10 (Interquartile range: 6-14). Hospital arrival was via EMS (3%), private transportation (50%) and transfer from another hospital (49%). Symptomatic intracranial hemorrhage was documented in 15 patients. Barriers of thrombolysis among patients otherwise eligible for thrombolysis included inability to afford tPA (n=15), patients/family refusal (n=32), delay in stroke diagnosis (n=6), and/or other in-hospital delays (n=9).
Conclusions: Thrombolysis is frequently administered in large academic hospitals in India, with acceptable safety. The relative lack of ambulance services, delay in arrival and diagnosis, and high cost of tPA are opportunities for infrastructure development.
Author Disclosures: J.D. Pandian: None. D. Khurana: None. S. Kaul: None. P. Sylaja: None. V. Padma: None. D. Arora: None. P. Kaur: None. T. Thankachan: None. A. Singhal: Research Grant; Significant; NINDS R21NS077442; NINDS U10 NS086729.
- © 2015 by American Heart Association, Inc.