Clinical re-audit of intravenous recombinant tissue plasminogen activator (r-tPA) recipients in ischemic stroke patients presenting at a tertiary care hospital, in Islamabad Pakistan (P4.319)

Objective: This clinical audit was conducted to assess the quality parameters: (1) Onset to arrival time (2) Door to needle time (3) Arrival to neuroimaging time, (4) Outcomes at 2 hours and 24 hours from baseline were measured by NIHSS and (5) Complications post r-tPA Background: Thrombolytic therapy for acute ischemic stroke using r-tPA (intravenous Alteplase) was initiated in January 2015 at Shifa International hospital, Islamabad and since then it is successfully being done. Design/Methods: This is a 2 year data from our stroke registry, during the period from 13th January 2015 to 31st January 2017. Patients with clinical presentation consistent with acute ischemic stroke, within 4.5 hours of hospital arrival, and a CT scan brain negative for any sort of intracranial bleed were included. Patients who did not consent to intravenous r-tPa administration or having any contraindication to I/V t-PA were excluded. The data was entered and analyzed using SPSS version 21 software. Results: 41 patients out of 1172 received intravenous r-tPA over 2 years period,12 were males (29.3 %) and 29 females (70.7%). Mean age at presentation was 66 years (SD ± 13.27). The mean time to stroke symptoms onset to arrival in emergency department was 85 minutes (SD ± 55 ); mean door to scan time was 12.7 minutes (SD ± 11.1) and mean door to needle time for administration of r-tPa was 50.3 minutes (SD ± 24.5). Median improvement of 4 points and 8 points on the NIHSS scale was seen in our patients 2 hours and 24 hours post intravenous r-tPA. Three patients had minor bleed and two patients died post r-tPA; one due to large stroke and other due to aspiration pneumonia. Conclusions: We can conclude that we are maintaining standards as per International protocols. The ongoing services are adequate but can be improved as highlighted in recommendations section. Study Supported by: N/A Disclosure: Dr. Zafar has nothing to disclose. Dr. Shoaib has nothing to disclose. Dr. Tariq has nothing to disclose. Dr. Haq has nothing to disclose. Dr. Hassan has nothing to disclose. Dr. Shamael has nothing to disclose.