Thrombolytic therapy for acute stroke in Mexico: Experience of four Mexican hospitals

Abstract

Background: Although the efficacy of intravenous thrombolysis (IV-T) has been widely demonstrated, the rates of its use continue to be low. Purpose: The purpose of this study was to assess the frequency of IV-T in Mexican hospitals and to describe the target times for acute treatment and the functional evolution of patients. Methods: Data prospectively collected from patients with acute ischemic stroke treated over a period of 2 years in four Mexican hospitals were analyzed. We assessed demographic data, the onset-to-door (OTD) time, the door-to-needle (DTN) time, treatment and the National Institutes of Health Stroke Scale (NIHSS), and modified Rankin scale (mRs) scores at the baseline and at the end of the follow-up. Results: There were 500 patients (mean age 57 ± 14 years, 274 [55%] men). The median OTD time was 11 h (range 30 min-190 h); the mean of NIHSS score was 10 ± 6. Eighty-seven (17.4%) patients arrived at the hospital within 4.5 h; but only 38 (7.6%) patients were treated with IV-T (mean of NIHSS 12 ± 6 points; with a mean OTD time of 2.1 h and a DTN time of 82 ± 51 min). After a median follow-up of 6 months (range 5-24 months), the final NIHSS score was 7 ± 6 points. A better prognosis was observed (mRs < 2) in patients who received IV-T (p = 0.04). Conclusions: The frequency of IV-T in Mexican hospitals continues to be <10%. A high percentage of patients continues to arrive at the hospital outside the therapeutic window.

Barriers to Optimal Acute Management of Stroke: Perspective of a Stroke Center in Mexico City

“…As a consequence, only 35% of all acute ischemic strokes arrived within the 4.5 h time window for thrombolysis, leaving more than half of the patients with acute IS out of reperfusion treatment. Nevertheless, it was possible to thrombolize 17.8% of the patients with a mean DTN time of 37 ± 10 min, a percentage higher than that previously reported in the Mexican health system (7.6%) and with shorter thrombolysis times (previous mean DTN time 81 ± 51 min) ( 5 ); these findings may be secondary to greater experience in our stroke center, which may not reflect reality in the rest of the country. In previous studies, the main barrier to optimal stroke treatment, according to the health professionals, was health staff capacity (especially lack of a stroke team) ( 6 ), a factor that we do not consider to have a great influence in our tertiary hospital but, as previously mentioned, may not represent the situation throughout Mexico.…”

“…In general, the mortality rate of stroke has been cut in half in high-income countries but reduced by only 15% in LMICs ( 4 ). In ischemic stroke (IS), the frequency of intravenous thrombolysis (IVT) use in Mexican hospitals is <10%, mainly because patients continue to arrive outside the therapeutic window ( 5 ).…”