Frequency of stroke patients qualified for recombinant tissue plasminogen activator (r-TPA) injection and limitations in Zahedan 2016


  • Alireza Khosravi Clinical Immunology Research Center, Department of Neurology, Zahedan University of Medical Science, Zahedan, Iran
  • Mohammad-Taghi Farzadfard Department of Neurology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
  • Arezoo Abdollahpour Clinical Immunology Research Center, Department of Neurology, Zahedan University of Medical Science, Zahedan, Iran



Ischemic stroke, Recombinant tissue plasminogen activator (r-TPA), Restriction


Background: Stroke is one of the common causes of mortality and disability. By introducing r-TPA into the global drug market and its effect on the patients’ prognosis, using this drug is recommended in all patients with ischemic stroke who visited less than 4.5 hours after stroke and do not have contraindications. The aim of this study was to investigate the frequency of stroke patients qualified for recombinant tissue plasminogen activator (r-TPA) and its limtations.

Methods: In this descriptive cross-sectional study, 244 patients examined with stroke admitted to the Neurology Department of Zahedan city hospital in 2016. Information form were completed with demographic data, transmission method, referral time, CT scan preparation time, and the response of the patients' trials, and finally the data were inserted in SPSS.16 software and analysed by statistical methods.

Results: Out of all patients with ischemic stroke, 28 (11.5%) patients had contraindication to receive drug. Of 216 remain patients, 201 patients (93.1%) had no possibility to receive r-TPA due to the loss of golden time and only 15 patients (6.9%) had possibility to receive drug because of visited 4.5 hours before the beginning of symptoms. Of them, 3 (20%) patients due to delay in CT scan and test results, had no possibility to receive r-TPA. In summary, of all patients with inclusion criteria, only 12 (5.5%) patients could use the r-TPA in this study.

Conclusions: The most important barrier to using r-TPA has been the loss of golden time and training to raise awareness of the society can lead to early referral from the onset of stroke symptoms.


Towfighi A, Saver JL. Stroke declines from third to fourth leading cause of death in the United States: historical perspective and challenges ahead. Stroke. 2011;42(8):2351-5.

Lashgharipoor K, Moghtaderi A, Sadjadi A, Faghihinia M. Prevalence of post stroke depression and its relationship with disability and lesion location. Journal of Fundamentals of Mental Health 2008;10 (39):191-9.

Koton S, Schneider AL, Rosamond WD, Shahar E, Sang Y, Gottesman RF, et al. Stroke incidence and mortality trends in US communities, 1987 to 2011. JAMA. 2014;312(3):259-68.

Feigin VL, Forouzanfar MH, Krishnamurthi R, Mensah GA, Connor M, Bennett DA, et al. Global and regional burden of stroke during 1990–2010: findings from the Global Burden of Disease Study 2010. Lancet 2014;383(9913):245-54.

Hosaini S.A, Bazrafshan H. A statistical study on the role of high-risk factors in the incidence of CVA. J Gorgan Univ Med Sci. 2001;3(2):76-80.

Khaw k. Epidemiology of stroke. J Neurol Neurosurg Psychiatry. 1996;61(4):333-8.

Lees KR, Bluhmki E, von Kummer R, Brott TG, Toni D, Grotta JC. Time to treatment with intravenous alteplase and outcome in stroke: an updated pooled analysis of ECASS, ATLANTIS, NINDS, and EPITHET trials. Lancet. 2010;375(9727):1695-703.

Boudreau DM, Guzauskas GF, Chen E, Lalla D, Tayama D, Fagan SC, et al. Cost-effectiveness of recombinant tissue-type plasminogen activator within 3 hours of acute ischemic stroke: current evidence. Stroke 2014;45(10):3032-9.

Bambauer KZ, Johnston SC, Bambauer DE, Zivin JA. Reasons Why Few Patients with Acute Stroke Receive Tissue Plasminogen Activator. Arch Neurol. 2006;63(5):661-4.

Kasmaei HD, Baratloo A, Nasiri Z, Soleymani M, Yazdani MO. Recombinant tissue plasminogen activator administration in patients with cerebrovascular accident; a case series. Arc Neurosci. 2015;2(2).

Hatamabadi HR, Mansouri H, Asarzadegan F, Shojaee M. Barriers to On Time Delivery of Thrombolytic Therapy. J Mazandaran Univ Med Sci. 2013;23(102):107-10.

Maghoul A, Rezazadeh Kh, Majidinia M, Tadvinfar M, Akaberi A. Study of the prevalence of CVA cardiac Risk Factors in sabzevar (2005-2006). Beyhagh; J Sabzevar School Med Sci. 2007;15(1):11-6.

Mazaheri S, Beheshti F, Hosseinzadeh A, Mazdeh M, Ghiasian M. Epidemiologic Study of Cardinal Risk Factors of Stroke in Patients Who Referred to Farshchian Hospital of Hamadan during 2014-2015. Sci J Hamadan Univ Med Sci. 2016;22 (4):331-7.

Iranmanesh F, Salehi M, Bakhshi H, Arab R. Silent stroke and related risk factors. J Gorgan Univ Med Sci. 2013;15(1):90-4.

Mojdehipanah H, Yazdi Z, Nasiri MS, Azizlo Z. Barriers to delivery of tissue plasminogen activator for patients with acute ischemic stroke. Feyz J Kashan Uni Med Sci. 2015;19.

Casetta I, Granieri E, Gilli G, Lauria G, Rosaria Tola M, Paolino E. Temporal trend and factors associated with delyed hospital admission of stroke patient. Neuroepidemiol. 1999;18:255-64.




How to Cite

Khosravi, A., Farzadfard, M.-T., & Abdollahpour, A. (2017). Frequency of stroke patients qualified for recombinant tissue plasminogen activator (r-TPA) injection and limitations in Zahedan 2016. International Journal of Basic & Clinical Pharmacology, 7(1), 7–10.



Original Research Articles