Influence of Socioeconomic Status on Patients' Choice of Thrombolytic Agent and its Outcome in Acute Ischemic Stroke.

IF 0.9 3区医学 Q4 NEUROSCIENCES Neurology India Pub Date : 2024-09-01 Epub Date: 2024-10-19 DOI:10.4103/neurol-india.ni_1187_21

Alex Rebello, Shiva Narayan Pattanayak, Subhangi Thakur Hameer, Megha Varshney, Manoj Kumar Goyal, Manish Modi, Vivek Lal

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Abstract

Background and objective: Alteplase, a recombinant tissue-type plasminogen activator (rtPA) is the only FDA-approved thrombolytic drug in acute ischemic stroke (AIS). Tenecteplase is a modified rtPA, which is cheaper. We aimed to study influence of socioeconomic status (SES) in patients' preference of thrombolytic agent and its outcome.

Methods: This prospective observational study conducted in PGIMER, a tertiary care center in India, recruited AIS patients thrombolyzed between July 2017 and September 2018. We studied variables including SES, thrombolytic agent chosen, and outcomes like National Institutes of Health Stroke Scale (NIHSS) scores at 24-h and at discharge; and modified Rankin Scale (mRS) after 3 months.

Results: Thirty-nine patients received tenecteplase and 39 patients received alteplase. Seven patients belonged to upper class, all of whom (100%) chose alteplase. Thirty patients belonged to upper middle class, of whom 25 (83.3%) and five (16.7%) patients chose alteplase and tenecteplase, respectively. Twenty-five patients belonged to lower middle class in which seven (28%) and 15 (72%) chose alteplase and Tenecteplase, respectively. Twenty patients were in upper lower class, of whom 4 (20%) and 16 (80%) chose alteplase and Tenecteplase, respectively. The difference in distribution of SES in tenecteplase and alteplase groups was significant (P = 0.000). Median 3 month-mRS scores were 3 and 3.5 in alteplase and tenecteplase groups, respectively (P = 0.608). There were no significant differences in NIHSS score improvement at 24 h postthrombolysis (P = 0.537) or at discharge (P = 0.429) among different SES categories. No correlation between SES and 3 month-mRS score was found (Spearman's ρ = 0.101, P = 0.398).

Conclusions: Majority of patients in upper and lower SES chose alteplase and Tenecteplase, respectively. However, there were no significant differences in outcomes among various SES categories.

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社会经济地位对急性缺血性脑卒中患者选择溶栓药物及其结果的影响

背景和目的：重组组织型纤溶酶原激活剂（rtPA）阿替普酶是美国食品及药物管理局批准的唯一治疗急性缺血性中风（AIS）的溶栓药物。替奈普酶是一种改良的 rtPA，价格更便宜。我们旨在研究社会经济地位（SES）对患者选择溶栓药物及其结果的影响：这项前瞻性观察研究在印度的一家三级医疗中心 PGIMER 进行，招募了 2017 年 7 月至 2018 年 9 月期间溶栓的 AIS 患者。我们研究了SES、所选溶栓药物等变量，以及24小时和出院时的美国国立卫生研究院卒中量表（NIHSS）评分、3个月后的改良Rankin量表（mRS）等结果：39名患者接受了替奈普酶治疗，39名患者接受了阿替普酶治疗。7名患者属于上层社会，他们全部（100%）选择了阿替普酶。30 名患者属于中上阶层，其中 25 人（83.3%）和 5 人（16.7%）分别选择了阿替普酶和替奈普酶。25 名患者属于中下阶层，其中 7 人（28%）和 15 人（72%）分别选择了阿替普酶和替奈普酶。20 名患者属于上下层阶级，其中 4 人（20%）和 16 人（80%）分别选择了阿替普酶和替尼酶。tenecteplase组和阿替普酶组的SES分布差异显著（P = 0.000）。阿替普酶组和替尼普酶组的 3 个月-mRS 评分中位数分别为 3 分和 3.5 分（P = 0.608）。在溶栓后 24 小时（P = 0.537）或出院时（P = 0.429），不同 SES 类别的 NIHSS 评分改善情况无明显差异。SES与3个月的mRS评分之间没有相关性（Spearman's ρ = 0.101，P = 0.398）：结论：大多数SES较高和较低的患者分别选择了阿替普酶和替奈普酶。结论：高社会经济地位和低社会经济地位的大多数患者分别选择了阿替普酶和替奈普酶，但不同社会经济地位的患者在治疗效果上没有明显差异。

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来源期刊

Neurology India 医学-神经科学

CiteScore

1.60

自引率

70.40%

发文量

434

审稿时长

2 months

期刊介绍： Neurology India (ISSN 0028-3886) is Bi-monthly publication of Neurological Society of India. Neurology India, the show window of the progress of Neurological Sciences in India, has successfully completed 50 years of publication in the year 2002. ‘Neurology India’, along with the Neurological Society of India, has grown stronger with the passing of every year. The full articles of the journal are now available on internet with more than 20000 visitors in a month and the journal is indexed in MEDLINE and Index Medicus, Current Contents, Neuroscience Citation Index and EMBASE in addition to 10 other indexing avenues. This specialty journal reaches to about 2000 neurologists, neurosurgeons, neuro-psychiatrists, and others working in the fields of neurology.