Thrombolysis for acute ischaemic stroke with tenecteplase in a developing country: challenges and experience from a prospective observational study

This study will emphasise the importance of Tenecteplase being ideally suited as a first-choice drug for thrombolysis in AIS in developing countries, considering the numerous challenges which are faced in these parts of the world.

To observe the effectiveness of Tenecteplase as a thrombolytic agent in AIS and also estimate the pre-hospital and in-hospital time delays in the treatment of such patients.

Eighteen patients with non-haemorrhagic strokes who presented within the window period were included. Eight patients were thrombolysed with Tenecteplase after due consent and ruling out contraindications. Reasons for the time delay, Ictus to Needle time and NIHSS scores were noted in each case.

The mean time from onset of symptoms to arrival at the hospital was 2.06 (± 1.08) h while the mean ictus to needle time was 4.29 (± 0.20) h The delay in carrying out a CT scan in these patients was 47.5 (± 16.69) min and mean time taken in procuring Tenecteplase was 27.5 (± 18.51) min. All patients were thrombolysed within 4.5 h of the onset of stroke and seven patients had statistically significant improved NIHSS scores in the post-thrombolysis period.

This paper highlights the constraints in the management of AIS in a developing country, where late presentation is the norm. In-hospital delays lead to diminishing window period available for thrombolysis. This paper highlights the successful use of Tenecteplase even in the late window period and emphasises Tenecteplase as a highly effective thrombolytic agent of choice in our setting. Further studies are likely to confirm these observations in the future.