Challenges and Outcomes of Thrombolytic Therapy in Acute Ischemic Stroke: The Iranian Perspective

Background: Acute ischemic stroke (AIS) is a leading cause of mortality and long-term disability worldwide. In Iran, AIS tends to occur nearly a decade earlier than in developed nations, presenting unique challenges. Intravenous recombinant tissue plasminogen activator (IV-rtPA) is an effective thrombolytic therapy for AIS, but various factors limit its utilization. Objectives: This study aimed to identify the barriers to the administration of IV-rtPA in AIS patients at Shahid Beheshti Hospital in Qom, Iran. Methods: A cross-sectional descriptive-analytical study was conducted on AIS patients admitted between November 2021 and September 2022. A total of 322 patients were screened, and 178 met the inclusion criteria. Data on demographic characteristics, stroke severity (NIHSS score), comorbidities, onset-to-door time, and reasons for not receiving IV-rtPA were analyzed using SPSS version 22. Results: Of the 178 patients, 87 (48.9%) received IV-rtPA, while 91 (51.1%) did not. The primary reasons for withholding thrombolysis were clinical improvement (37.4%), late hospital arrival beyond 4.5 hours (24.2%), lack of consent (20.9%), the physician's conservative approach (11%), and mild progression of stroke symptoms (6.6%). A significant correlation was found between NIHSS score and reasons for non-receipt of therapy (P < 0.001). Patients with a prior stroke history were more likely to experience delays due to a physician's conservative approach (28.6% vs. 5.7%, P < 0.01). Barriers to thrombolysis were also associated with lower education levels and a lack of public awareness about stroke symptoms. Conclusions: Delayed hospital admission and lack of consent were the leading barriers to IV-rtPA administration. Public awareness campaigns emphasizing the urgency of recognizing stroke symptoms and seeking timely medical care are crucial to improving thrombolysis rates and reducing AIS-related disabilities in Iran.