Comparison of neurological outcome between Stroke fast track patient who received rt-PA less than 45 minutes, 45-60 minutes and more than 60 minutes at Pattaya Bhattamakun (Banglamung) Hospital
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Abstract
Introduction: Acute ischemic stroke is a leading cause of disability and mortality in Thailand. Intravenous thrombolysis with rt-PA remains the standard treatment for eligible patients; however, outcomes vary, and the risk of intracerebral hemorrhage (ICH) remains a significant concern.
Objective: To evaluate the effectiveness of rt-PA thrombolytic therapy in Stroke Fast Track patients by comparing door-to-needle (DTN) times (<45, 45–60, and >60 minutes) and to identify risk factors associated with post-thrombolysis ICH.
Methodology: A retrospective study was conducted on acute ischemic stroke patients who received intravenous rt-PA within 4.5 hours between July 2022 and September 2023. Data included age, comorbidities, NIHSS at admission and discharge, and mRS at admission and 90 days. Outcomes were assessed using discharge NIHSS and 90-day mRS.
Results: Among 96 patients categorized by DTN times, no significant differences in discharge NIHSS or 90-day mRS were observed in the initial grouping. However, reclassification into <30, 31–45, and >45 minutes revealed significant differences in discharge NIHSS (P = 0.004), 90-day mRS (P = 0.015), and favorable outcomes (mRS 0–1, P = 0.003). The <30-minute group had significantly better outcomes than the 31–45 and >45-minute groups. ICH occurred in 9.375% of cases, with symptomatic ICH in 5.20%. Significant risk factors for ICH included advanced age (P = 0.046), atrial fibrillation (P = 0.031), and lower diastolic blood pressure (P = 0.008).
Conclusion: DTN time under 30 minutes is associated with improved functional outcomes following rt-PA therapy. Advanced age, atrial fibrillation, and lower diastolic blood pressure are significant predictors of post-thrombolysis ICH.
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