Short-Term Outcome of Ischemic Stroke after Thrombolytic Therapy with Recombinant Tissue Type Plasminogen Activator in a Hospital in Sylhet, Bangladesh

Author(s): Md. Nazrul Islam, Md. Matiur Rahman, Rahat Amin Chowdhury, Shiuli Rani Deb, Tania Islam, Md. Hafiz Ehsanul Hoque, K M Hafizur Rahman, Tamanna Tabassum Turna, Md Ariful Haque, Tasnim Mahmud

Background:

The incidence of ischemic stroke is increasing worldwide, including Bangladesh. Evidence showed that early initiation of thrombolysis therapy correlated with better functional outcome of the patients. The drug recombinant tissue type plasminogen activator (rtPA) is using in thrombolysis therapy successfully for several years. The objective of this study was to compare short-term outcome of thrombolysis therapy by rtPA between the patients’ group of with and without thrombolysis therapy.

Methodology:

This open-labeled non-randomized negatively controlled clinical trial conducted at Neurology unit of Mount Adora Hospital,Sylhet. The investigating group was treated with intravenous rtPA at a dose of0.6mg/kgbody-weight and administered within 4.5 hours of onset of disease and after proper diagnosis. Age and sex matched negatively controlled group used to compare. The modified Rankin Scale (mRS) was the outcome variable.

Result:

Thirty-one patients of acute ischemic stroke included for rtPA therapy and they were compared with similar number of agesex matched ischemic stroke patients those who came after the window period of rtPA therapy or not agreed to take the drug therapy. Both the study groups found matched for their age (p = 0.92), sex (p = 1.00), hypertension (p = 1.00), diabetes mellitus (p = 0.47), ischemic heart disease (p = 1.00) and smoking habit (p = 0.31) in this study. Clinical evaluation before starting the therapy found similarity of clinical laterality (p = 0.45), cranial nerve involvement (p = 0.25), sensory affected (p = 0.47), motor deficit (p = 0.20), number of lesion (p = 0.42), TOAST subtype (p = 0.89) in this study. The Modified Ranking Scale (mRS) score before starting the therapy was 30.71 among rtPA group and 32.29 in non rtPA group, which was not significantly differ (p = 0.723). The mean rank found significant on discharge (36.68 in non rtPA groupand 26.32 in rtPA group, p = 0.021) and after 3 months of the therapy (37.76 in non rtPA groupand 25.24 in rtPA group, p = 0.006). There was no serious adverse effect of rtPA observed in this study.

Conclusion:

This study revealed favorable functional outcome of rtPA therapy in acute ischemic stroke patients when given within the window period of the therapy.