Awareness of alteplase therapy for acute ischemic stroke among postgraduate residents in public and private hospitals of Khyber Pakhtunkhwa
DOI:
https://doi.org/10.59736/IJP.24.03.1125Keywords:
Alteplase, Acute Ischemic Stroke, Postgraduate Residents, Khyber PakhtunkhwaAbstract
Background: Acute ischemic stroke (AIS) is a predominant cause of death and prolonged disability, globally. Intravenous alteplase (tPA) is the mainstay treatment when administered within therapeutic timeframe. In low and middle-income countries like Pakistan, treatment delays frequently stem from insufficient awareness among healthcare professionals. This study evaluated the knowledge, attitudes, and behaviors of postgraduate residents at public and private hospitals of Khyber Pakhtunkhwa regarding the use of intravenous alteplase in the management of acute ischemic stroke.
Methods: A cross-sectional study was conducted from January to June 2025 among 206 postgraduate residents from various public and private-sector hospitals of Khyber Pakhtunkhwa using a validated questionnaire adapted from Al Khathaami et al. Knowledge was evaluated using three fundamental criteria (effectiveness, standard of treatment, recommendation), resulting in a Knowledge Score from 0-3. Statistical investigations included t-tests, one-way ANOVA with post-hoc evaluations, and multivariable linear regression to identify the determinants of knowledge.
Results: The average Knowledge Level Score was 2.81 ± 0.63, with 89.8% of individuals attaining the highest level. No notable differences were detected between inhabitants of public and private institutions (p = 0.882) or among residency years (p = 0.234). Multivariable regression indicated no significant determinants of knowledge (R² = 0.009, p = 0.880). Notwithstanding robust foundational knowledge, 10% of participants exhibited hesitance in endorsing tPA, attributing their reservations to worries over bleeding (52.9%), insufficient experience (35.0%), and medico-legal implications (3.4%). Notably, 86.4% indicated a readiness to pursue additional training, while 72.3% endorsed tele-stroke consulting methods.
Conclusion: Postgraduate residents in Khyber Pakhtunkhwa exhibit substantial basic knowledge of intravenous alteplase in acute ischemic stroke, regardless of training year or type of institution. Obstacles to implementation originate from attitudes, self-assurance, and medico-legal issues.
References
Campbell BCV, De Silva DA, Macleod MR, Coutts SB, Schwamm LH, Davis SM, et al. Ischaemic stroke. Nat Rev Dis Primers. 2019;5(1):70.
Pu L, Wang L, Zhang R, Zhao T, Jiang Y, Han L. Projected global trends in ischemic stroke incidence, deaths and disability-adjusted life years from 2020 to 2030. Stroke. 2023;54(5):1330-9.
Joseph P, Leong D, McKee M, Anand SS, Schwalm JD, Teo K, et al. Reducing the global burden of cardiovascular disease, part 1: the epidemiology and risk factors. Circ Res. 2017;121(6):677-94.
Suwanwela NC, Poungvarin N. Stroke burden and stroke care system in Asia. Neurol India. 2016;64 Suppl 1:S46-51.
Albers GW, Bates VE, Clark WM, Bell R, Verro P, Hamilton SA. Intravenous tissue-type plasminogen activator for treatment of acute stroke: the Standard Treatment with Alteplase to Reverse Stroke (STARS) study. JAMA. 2000;283(9):1145-50.
Pan Y, Shi G. Silver jubilee of stroke thrombolysis with alteplase: evolution of the therapeutic window. Front Neurol. 2021;12:593887.
Cronin CA. Intravenous tissue plasminogen activator for stroke: A review of the ECASS III results in relation to prior clinical trials. The Journal of emergency medicine. 2010;38(1):99-105.
Barreto AD. Intravenous thrombolytics for ischemic stroke. Neurotherapeutics. 2011;8(3):388-99.
Dewar B, Shamy M. tPA for acute ischemic stroke and its controversies: a review. Neurohospitalist. 2020;10(1):5-10.
Farooq A, Essa M, Shafique N, Gull S. Hurdles of intravenous thrombolysis in acute ischemic stroke at Balochistan. Pak J Neurol Sci. 2022;17(4).
Cumbler E, Murphy P, Jones WJ, Wald HL, Kutner JS, Smith DB. Quality of care for in-hospital stroke: analysis of a statewideregistry. Stroke. 2011;42(1):207-10.
Emiru T, Adil MM, Suri MFK, Qureshi AI. Thrombolytic treatment for in-hospital ischemic strokes in United States. J Vasc Interv Neurol. 2014;7(5):28.
Lu M-Y, Chen C-H, Yeh S-J, Tsai L-K, Lee C-W, Tang S-C, et al. Comparison between in-hospital stroke and community-onset stroke treated with endovascular thrombectomy. Plos one. 2019;14(4):e0214883.
Cumbler E, Zaemisch R, Graves A, Brega K, Jones W. Improving stroke alert response time: applying quality improvement methodology to the inpatient neurologic emergency. J Hosp Med. 2012;7(2):137-41.
Ding GB, Sang Q, Han HJ, Wang XM, Wu YF. Assessment of stroke knowledge and awareness among primary healthcare providers: a cross-sectional survey from the Kezhou quality improvement in acute stroke care project. Front Public Health. 2023;11:1136170.
Wechsler LR, Demaerschalk BM, Schwamm LH, Adeoye OM, Audebert HJ, Fanale CV, et al. Telemedicine quality and outcomes in stroke: A scientific statement for healthcare professionals from the American Heart Association/American.Stroke Association. Stroke. 2017;48(1):e3-e25.
Lezzi P, Lupo R, Lezzi T, Conte L, Vitale E. The nursing role in the mobile stroke unit for the treatment of ischemic stroke. A review of the literature.
Al Khathaami AM, Aloraini H, Almudlej S, Al Issa H, Elshammaa N, Alsolamy S. Knowledge and attitudes of Saudi emergency physicians toward t-PA use in stroke. Neurol Res Int. 2018;2018:3050278.
Algarni RM, Albarrak MM, Alomaysh AM, Morsi AA, Lin C, Almowalad ES, et al. Stroke intervention and pharmac otherapy guidelines: knowledge-to-practice translation gaps among the emergency resident physicians in Riyadh, Saudi Arabia. J Clin Neurosci. 2023;110:109-15.
Ziaee M, Mirzaasgari Z, Chardoli M, Hoveidamanesh S, Zamani B, Zeinali M, et al. Attitude and knowledge of emergency medicine professionals regarding the use of tissue plasminogen activator in the treatment of acute ischemic stroke: a cross-sectional study. Sci Inf Database. 2022.
Ahmed HJ, Yassin R, Yassin D, Elkhidir I, Elkhidir IH. Knowledge and attitude of Sudanese emergency registrars towards the use of tissue plasminogen activator in the management of acute ischemic stroke. Cureus. 2022;14(10).
Rossis C, Michail KA, Middleton N, Karanikola M, Papathanassoglou E, Mpouzika M, editors. Knowledge on stroke recognition and management among emergency department healthcare professionals in the Republic of Cyprus. In Healthcare. 2023: MDPI.
Iqbal A, Haider SA, Kazmi SAR. Limitations to intravenous thrombolytic therapy in acute ischemic stroke in our settings. Pak J Med Health Sci. 2016;10(3):1047-9.
Bulmer T, Volders D, Kamal N. Analysis of thrombolysis process for acute ischemic stroke in urban and rural hospitals in Nova Scotia, Canada. Front Neurol. 2021;12:645228.
Aaron S, Alexander M, Maya T, Mathew V, Goyal M. Treatment of acute ischemic stroke: awareness among general practitioners.NeurolIndia.2010;58(3):441-2.
Scott PA, Xu Z, Meurer WJ, Frederiksen SM, Haan MN, Westfall MW, et al. Attitudes and beliefs of Michigan emergency physicians toward tPA use in stroke: baseline survey results from the INSTINCT Trial hospitals. Stroke. 2010;41(9):2026.
Downloads
Published
Issue
Section
License
Copyright (c) 2026 Natasha Junaid, Furqan Ahmed Sethi, Muhammad Saleh Faisal, Laiba Zahir
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Readers may “Share-copy and redistribute the material in any medium or format” and “Adapt-remix, transform, and build upon the material”. The readers must give appropriate credit to the source of the material and indicate if changes were made to the material. Readers may not use the material for commercial purpose. The readers may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.
