Abstract TP6: Determinants Of Thrombolytic Administration For Acute Ischemic Stroke At A Large Tertiary Center In Lebanon

Background: Thrombolysis remains underutilized for acute ischemic stroke (AIS) in healthcare systems in low- and middle-income countries. Aims: We aimed to investigate the factors associated with utilization of intravenous thrombolysis in an academic medical center in Lebanon. Methods: Patients presenting to a tertiary medical center in Lebanon between January 2015 and October 2019 were reviewed. Inclusion criteria were age greater than 18 years and presenting to the emergency department within 48 hours from last known well. Patient, disease, and health system response characteristics were collected and those eligible for and those who received thrombolysis within 4.5 hours onset by guidelines criteria were identified by chart review. Descriptive statistics, bivariate and multivariate analyses were performed for association with thrombolysis administration. Results: Of 373 AIS patients presenting within 48 hours of onset to the hospital, 65 (17.4%) were deemed to be candidates for thrombolysis. Forty (61.5% of eligible) received thrombolysis. Those receiving thrombolysis compared to eligible but not receiving thrombolysis were younger (median 72 vs 86, p=0.018), had higher NIHSS (median 11.5 vs 7, p=0.032), had greater likelihood of stroke code activation (79% vs 41%, p=0.011), and no anti-platelet use (22.5% vs 56%, p=0.021). The multivariate analysis showed that thrombolysis among eligible patients associated with younger age (OR 1.05 [1.01-1.10], p=0.029), a higher NIHSS (OR 1.12 [1.01-1.25], p=0.041), and stroke code activation (OR 2.81 [1.16-6.81], P=0.022). Conclusion: A good proportion of eligible AIS patients did not receive thrombolysis. To increase thrombolysis use in low- and middle-income countries, more consistent stroke code activation and education on age and stroke severity in eligibility are needed.