Hurdles of intravenous thrombolysis in acute ischemic stroke at Balochistan

Background and objective: Intravenous thrombolysis (IVT) with alteplase tPA (tissue plasminogen Activator) is the FDA approved treatment for acute ischemic stroke. The objective of this study was to determine the hurdles of intravenous thrombolysis in acute ischemic stroke in Balochistan. Methods: A prospective cross-sectional observational study was carried out from June 2021 to December 2021 at Neurology department of Bolan Medical Complex Hospital Quetta on 272 patients of acute ischemic stroke who fulfilled the criteria. Proforma was filled by relative or patient after informed consent. Proforma included sex, age, diagnosis, time of presentation after stroke and reason of delay. Data was collected, tabulated, and statistically analyzed using an IBM Statistical Package for the Social Sciences (SPSS), version 20. Results: Out of 272 patients, 156 patients were male and 116 patients were female. Only two patients presented within 4.5 hours of onset of acute ischemic stroke, 27 patients within 13- 24 hours,44 patients within 25-72 hours and 171 patients beyond three days. Two-hundred patients first took advice from faith healer (peer), 50 patients from general practitioner and 22 patients preferred neurologist. Conclusion:  Very few patients presented within Alteplase window. Major reason of delay was contacting faith healer first. There is necessity of awareness campaigns to overcome this hurdle and to minimize barriers for improving access to thrombolysis and specialized stroke care in Balochistan.