Implementation of emergency-based thrombolysis : an achievable option for rural hospitals in developing countries
Background In developing countries such as Malaysia, the primary mode for revascularization is via thrombolytic therapy. This is only effective when instituted within a small time window and pre-hospital delay is a major concern. In a region where the mean house-to-door times can be as long as 8.5...
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| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Springer New York LLC
2008
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| Subjects: | |
| Online Access: | http://irep.iium.edu.my/5251/1/Combined_Circulation_Abstracts%5B1%5D.pdf http://irep.iium.edu.my/5251/ http://apps.webofknowledge.com/full_record.do?product=WOS&search_mode=GeneralSearch&qid=4&SID=T2ADnb8FamD8DhD@H8j&page=1&doc=1 |
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| Summary: | Background In developing countries such as Malaysia, the primary mode for revascularization is via thrombolytic therapy. This is only effective when instituted within a small time window and pre-hospital delay is a major concern. In a region where the mean house-to-door times can
be as long as 8.5 hours, there is an urgent need to reduce the door-to-needle times. Methods Emergency-based thrombolysis was initiated at Hospital Tengku Ampuan Afzan Kuantan, a 600-bed regional hospital in Malaysia. One hundred and thirty three patients with acute ST elevation myocardial infarction patients were screened. 39 patients were recruited in the 4 months prior to the implementation date and 94 patients were recruited after. The mean
house-to-door, door-to-needle times were recorded. Results The majority of patients were male 88.7%, with a mean age of 56.4 � 10.3 years. The median presentation time (house-to-door) was 117.50 minutes before and 136.00 minutes after (p � 0.213, Mann- Whitney U) minutes. The median door-to-needle time was 100.00 minutes before and 50.00 minutes after (p � 0.031). The mortality rates were 12.8% before and 11.70% (p�0.87, Fisher exact test) after mplementation of Emergency-based thrombolysis. Conclusion Implementation
of Emergency-based thrombolysis has markedly improved the door-to-needle times and resulted in a trend towards reduced mortality rates in acute ST-elevation myocardial infarction. |
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