Background: Stroke is the leading cause of death and disability. Nowadays, the standard treatment is Intravenous thrombolytic with alteplase (t-PA) within 4.5 hours after the stroke onset. However, some patients who arrived to the hospital within 4.5 hours after stroke onset haven’t received the alteplase.

Objective: To investigate the barriers to thrombolysis drug (alteplase) in acute ischemic stroke patients who arrived at the hospital within 4.5 hours after the stroke onset.

Materials and Methods: A retrospective study of ischemic stroke patients who developed stroke symptoms and arrived at the hospital within 4.5 hours but did not receive the thrombolytic drug (non-treatment group). Data were collected at the North-East hospital of Thailand from the hospital stroke registry and the patient record from October 2014 to September 2015. The study focused on the reasons for which this group of patients was excluded from receiving the thrombolytic drug. Factors associated with the non-treatment group were investigated using multivariable logistic regression.

Results: Of a total 229 patients who were diagnosed with acute ischemic stroke and arrived within 4.5 hours after stroke onset, 61 patients underwent thrombolytic therapy with alteplase. Of the 168 patients who did not receive the alteplase, the main reasons for this were mild or improving symptoms, contraindication to alteplase and uncertain onset time (including wake-up strokes). Factors associated with the non-treatment group were door time over three hours and patients who had an underlying history of hypertension or an old cerebrovascular accident (CVA). These patients were less likely to receive the thrombolytic drug. While patients with a National Institute of Health Stroke Scale (NIHSS) between 8 and 12, were more likely to receive the treatment.

Conclusion: Barriers to use of the thrombolytic drug in acute ischemic stroke in Thai patients included mild or improved symptoms, relative contraindication to alteplase and uncertain onset time. In order to increase alteplase administration, the revision of relative contraindication in mild symptoms, seizure at onset of stroke and wake-up stroke or stroke with an uncertain time of onset should be considered. The application of neuroimaging can be useful to select the eligible cases.

Keywords: Acute ischemic stroke, Thrombolytic therapy, Alteplase, t-PA, rt-PA, r-tPA