INTRAVENOUS THROMBOLYSIS FOR MULTI-ETHNIC ASIANS WITH ACUTE ISCHAEMIC STROKE IN PRIMARY STROKE CENTRES VERSUS ACUTE STROKE READY HOSPITALS: COMPARISON OF SERVICE EFFICIENCY AND CLINICAL OUTCOMES
1 Department of Medicine, Tawau Hospital, Sabah, Malaysia.
2 Department of Medicine, Seberang Jaya Hospital, Penang, Malaysia.
3 Department of Medicine, Sarawak General Hospital, Sarawak, Malaysia
4 Department of Medicine, Queen Elizabeth Hospital, Sabah, Malaysia.
5 Department of Medicine, Sultanah Nur Zahirah Hospital, Terengganu, Malaysia.
6 Department of Medicine, Raja Permaisuri Bainun Hospital, Perak, Malaysia.
7 Department of Medicine, Taiping Hospital, Perak, Malaysia.
8 Department of Medicine, Bintulu Hospital, Sarawak, Malaysia.
9 Department of Medicine, Sarikei Hospital, Sarawak, Malaysia.
10 Department of Medicine, Sultan Abdul Halim Hospital, Kedah, Malaysia.
Intravenous thrombolysis (IVT) with recombinant tissue plasminogen activator is beneficial in acute ischaemic stroke (AIS), even when administered by non-neurologists in non-stroke centres. We aim to compare the safety and effectiveness of IVT in primary stroke centres (PSCs) equipped with neurologists versus acute stroke ready hospitals (ASRHs) without neurologists.
MATERIAL and METHOD:
We conducted a periodic cross-sectional study involving 5 PSCs and 7 ASRHs in Malaysia. Through review of medical records, real world data was extracted for analysis. Consecutive adults with AIS who received IVT from 01 January 2014 to 31 December 2020 were included. Univariate and multivariate regression models were employed to evaluate the role of PSCs versus ASRHs in post-IVT outcomes and complications. Statistical significance was set at p<0.05.
A total of 313 multi-ethnic Asians, namely 231 (74%) from PSCs and 82 (26%) from ASRHs, were included. Both groups were matched in demographic, baseline clinical, and stroke characteristics. The efficiency of IVT delivery (door-to-needle time), post-IVT functional outcomes (mRS at 3 months post-IVT), and rates of adverse events (intracranial haemorrhages and mortality) following IVT were comparable between the 2 groups (refer Table 1). Notably, 46.8% and 48.8% of patients in the PSCs and ASRHs group respectively (p=0.752) achieved favourable functional outcomes, namely mRS≤1 at 3 months post-IVT. Regression analyses demonstrated that post-IVT functional outcomes and adverse events were independent of the role of PSCs or ASRHs.
Our study provides translational real-world evidence which suggests that IVT can be equally safe, effective, and efficiently delivered in both PSCs and ASRHs, provided with strict adherence to evidence-based protocol. This may encourage the establishment of such service in more centres without neurologists, hence extending the benefits to a greater proportion of global stroke populations. Accordingly, development of ASRHs equipped with trained stroke teams should be advocated to enhance regional and international acute stroke care.