The Reasons Acute Stroke Patients Not Receiving Thrombolysis In An Indonesian Referral Hospital

Objective: The aim of this study was to identify reasons acute stroke patients did not receive thrombolysis despite meeting Code Stroke activation criteria in Cipto Mangunkusumo General Hospital during November 2015 until February 2019. Methods: This study retrospectively collected data of adult (aged>18 y old) acute stroke patients admitted to Cipto Mangunkusumo General Hospital from November 2015 to February 2019 who met criteria for Code Stroke activation but did not undergo thrombolysis. Patient’ data were collected from Code Stroke Registry of Cipto Mangunkusumo General Hospital. Results: There were 518 acute stroke patients who had Code Stroke activated in Cipto Mangunkusumo General Hospital from November 2015 to February 2019. 76.3% of acute stroke patients did not receive thrombolytic therapy (n=395). Hemorrhage on computed tomography (CT) scan was the most common reason patients did not receive thrombolysis. The following most common reasons were low or improved National Institutes of Health Stroke Scale (NIHSS) score, family refusal, and exceedance of time window. Conclusion: Hemorrhage on CT scan was the most common reason patients did not receive thrombolysis following by low or improved NIHSS score, family refusal, and exceedance of time window.

Blood Viscosity As A Determining Factor Of Ischemic Stroke Outcomes Evaluated With Nihss And Mrs On Day 7 And 30 Post-Thrombolysis

Objective: This study aimed to analyze blood viscosity as a determining factor of ischemic stroke outcomes evaluated with National Institutes of Health Stroke Scale (NIHSS) and modified Rankin Scale (mRS) on day 7 and 30 post-thrombolysis. Methods: This study was a 4-months cohort study taking place in Cipto Mangunkusumo General Hospital from January to April 2017. Subjects were collected at the Emergency Department or Neurology Outpatient Department. Eligible patients gave informed consent. Patients underwent numerous examinations, including blood viscosity test using digital microcapillary (DM) instrument. Outcomes of patients were identified on day 7 and day 30 post-thrombolysis using NIHSS and mRS, respectively. Results: Most acute ischemic stroke patients (88.6%) had blood hyperviscosity. 9.1% patients had poorer neurologic deficit on day 7 evaluated with NIHSS and 18.2% patients had poor outcome on day 30 evaluated with mRS. All patients with normal blood viscosity did not have a poorer neurologic deficit on day-7-evaluation. Conclusion: Blood viscosity determines the outcomes of acute ischemic stroke patients on day 7 and day 30 post-thrombolysis.

Efficacy Of Low-Dose Thrombolysis With Intravenous Alteplase Within 6 H Of Acute Ischemic Stroke Onset: Evidence From Single Referral Center In Indonesia

Objective: This study evaluated the efficacy of thrombolysis with 0.6 mg/kg intravenous alteplase for acute ischemic stroke patients within 6 h of stroke onset. Methods: This cross-sectional study collected data of patients with ischemic stroke received intravenous thrombolytic therapy with 0.6 mg/kg alteplase within 6 h of onset in Cipto Mangunkusumo General Hospital (Rumah Sakit Cipto Mangunkusumo [RSCM]) between November 2014 and August 2017. Efficacy of the thrombolytic therapy was evaluated using the National Institutes of Health Stroke Scale (NIHSS) and modified Rankin Scale (mRS). NIHSS evaluated on 24 h and 7 d post thrombolytic therapy portrayed clinical outcomes of patients while mRS evaluated on day 30 post-thrombolysis portrayed the functional outcome of patients. Results: The median NIHSS score decreased on 24 h and 7 d post-thrombolysis. 33.3% patients experienced a reduction of NIHSS score ≥4 on 24 h post thrombolytic therapy. On day 7 following thrombolysis, 57.4% patients had a good clinical outcome. On day 30 follow-up, 55.6% patients had a good functional outcome. Conclusion: Thrombolysis using 0.6 mg/kg intravenous alteplase within 6 h of onset is effective for acute ischemic stroke patients.