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首页> 外文期刊>Journal of stroke and cerebrovascular diseases: The official journal of National Stroke Association >Utilization of Intravenous Tissue Plasminogen Activator and Reasons for Nonuse in Acute Ischemic Stroke in Saudi Arabia
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Utilization of Intravenous Tissue Plasminogen Activator and Reasons for Nonuse in Acute Ischemic Stroke in Saudi Arabia

机译：沙特阿拉伯急性缺血性脑卒中静脉内组织纤溶酶原激活剂的利用及其原因

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Background: Recombinant tissue plasminogen activator (rt-PA, alteplase) within 4.5 hours of symptom onset decreases the rate of disability after acute ischemic stroke (AIS). Due to various reasons, alteplase remains underutilized in certain regions (similar to 3% in low- and middle-income countries). Aims: We aimed to estimate the alteplase utilization rate and identify the reasons for nonuse in Saudi Arabia. Methods: We retrospectively reviewed all patients admitted with suspected stroke in the past 24 hours to the stroke unit at King Abdulaziz Medical City, Riyadh, Saudi Arabia from February 2016 to July 2018. We estimated the alteplase utilization rate among patients with AIS who could be treated within 4.5 hours of symptoms onset (<= 225 minutes, allowing 45 minutes for door to needle time). We examined potential predictors of alteplase use using multivariable logistic regression analyses. Study was approved by local IRB. Results: Of 1366 patients with suspected stroke, 819 (60%) had AIS. The alteplase utilization rates were 8.6% and 29% for all AIS and AIS arrived within the therapeutic window, respectively. The most common reason for no alteplase treatment was late arrival. Only 244 (29.8%) of AIS patients arrived within the time window for treatment. Among patients with sudden neurological deficit who arrived within the therapeutic time window, the most common reasons were mild neurological deficit (National Institutes of Health Stroke Scale score <5, 29.9%), stroke mimics (16.6%), and hemorrhagic stroke (8.1%). Conclusions: Our study showed a comparable alteplase utilization rate with most international estimates. The low utilization rate was mainly attributed to late patient arrival. Urgent interventions are needed to improve public awareness of stroke recognition and prehospital stroke care.
机译：背景：在症状出现后4.5小时内使用重组组织纤溶酶原激活剂（rt-PA，alteplase）可降低急性缺血性卒中（AIS）后的致残率。由于各种原因，阿替普酶在某些地区仍然未得到充分利用（类似于中低收入国家的3%）。目的：我们旨在估计阿替普酶的使用率，并确定沙特阿拉伯不使用阿替普酶的原因。方法：我们回顾性分析了2016年2月至2018年7月在沙特阿拉伯利雅得阿卜杜勒-阿齐兹国王医疗城卒中单元住院的所有疑似卒中患者。我们估计了可以在症状出现后4.5小时内治疗的AIS患者的阿替普酶利用率（<=225分钟，门到针时间为45分钟）。我们使用多变量逻辑回归分析研究了阿替普酶使用的潜在预测因素。这项研究得到了当地IRB的批准。结果：在1366例疑似中风患者中，819例（60%）患有AIS。所有AIS和到达治疗窗口的AIS的阿替普酶利用率分别为8.6%和29%。没有阿替普酶治疗的最常见原因是到达时间晚。只有244名AIS患者（29.8%）在治疗时间窗口内到达。在治疗时间窗内出现突发性神经功能缺损的患者中，最常见的原因是轻度神经功能缺损（美国国立卫生研究院卒中量表评分<5,29.9%）、模拟卒中（16.6%）和出血性卒中（8.1%）。结论：我们的研究显示，阿替普酶的利用率与大多数国际估计值相当。利用率低的主要原因是患者到达时间晚。需要紧急干预措施来提高公众对中风识别和院前中风护理的认识。

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