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Malaeb D, Hallit S, Sakr F, Dabbous M, Saadeh W, Mansour S, Cherri S, Sarayeldyine SA, Salameh P, Hosseini H. The use of intravenous thrombolytics in acute ischemic stroke management: A scoping review from 2008 till 2021 in the Arab world in the Middle East and North Africa. J Stroke Cerebrovasc Dis 2023; 32:107201. [PMID: 37290154 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 05/09/2023] [Accepted: 05/25/2023] [Indexed: 06/10/2023] Open
Abstract
OBJECTIVE The aim of this review was to assess and analyze the research output on intravenous thrombolysis in acute ischemic stroke in the Arab world in the Middle East and North Africa. METHODS Published literature on intravenous thrombolysis for acute ischemic stroke from 2008 to 2021 were retrieved from several electronic databases. Extracted records were analyzed in terms of year of publication, country, journal, research area, authors, and organizational affiliations. RESULTS A total of 37 studies were published between 2008 and 2021 from different Arab countries. Eight studies assessed the safety and efficacy of thrombolytic agents in AIS. Three studies were KAP studies addressing the knowledge, attitude and practice towards IVT. The majority of the selected studies (n=16) discussed the utilization rate of IVT among patients in different hospital settings across these countries. Ten studies reported the outcomes associated with the use of IVT for AIS. CONCLUSION This is the first scoping review to study the research activity related to the use of IVT in stroke in the Arab nations. In the last 15 years, stroke research productivity was very low in the Arab world compared to other regions of the world due to several impeding factors. Given the high burden of in-adherence to acute stroke treatment in the Arab nations, there is a serious need for an increased high-quality research activity to highlight the roadblocks associated with the limited use of IVT.
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Affiliation(s)
- Diana Malaeb
- College of Pharmacy, Gulf Medical University, Ajman, United Arab Emirates; School of Pharmacy, Lebanese International University, Beirut, Lebanon.
| | - Souheil Hallit
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik (USEK), P.O Box: 446, Jounieh lebanon; Research Department, Psychiatric Hospital of the Cross, Jal Eddib, Lebanon; Applied Science Research Center, Applied Science Private University, Amman, Jordan
| | - Fouad Sakr
- School of Pharmacy, Lebanese International University, Beirut, Lebanon; INSPECT-LB (Institut National de Sant e Publique, d'Épid emiologie Clinique et de Toxicologie-Liban); UMR U955 INSERM, Institut Mondor de Recherche Biomédicale, Université Paris-Est Créteil, 94010 Créteil, France; École Doctorale Sciences de la Vie et de la Santé, Université Paris-Est Créteil, 94010 Créteil, France
| | - Mariam Dabbous
- School of Pharmacy, Lebanese International University, Beirut, Lebanon
| | - Wadih Saadeh
- Faculty of Pharmacy, Lebanese University, Beirut, Lebanon; Faculty of Public health, Lebanese University, Fanar, Lebanon
| | - Sara Mansour
- School of Pharmacy, Lebanese International University, Beirut, Lebanon
| | - Sarah Cherri
- School of Pharmacy, Lebanese International University, Beirut, Lebanon
| | | | - Pascale Salameh
- INSPECT-LB (Institut National de Sant e Publique, d'Épid emiologie Clinique et de Toxicologie-Liban); Faculty of Pharmacy, Lebanese University, Beirut, Lebanon; Department of Primary Care and Population Health, University of Nicosia Medical School, Nicosia, Cyprus; School of Medicine, Lebanese American University, Byblos, Lebanon
| | - Hassan Hosseini
- INSERM U955-E01, IMRB, Henri Mondor Hospital, Créteil, France; Department of Neurology, Henri Mondor Hospital, AP-HP, Créteil, France
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Khatri IA, AlSkaini M, AlDayel A, Qamra A, Masuadi E, AlShammari M, AlKhalaf A, AlRasheed D, AlKhathaami A, AlOtaibi N, Tarawneh M, AlHizan K. Patterns and outcomes of stroke thrombolysis in a large tertiary care hospital in Riyadh, Saudi Arabia. ACTA ACUST UNITED AC 2021; 26:199-206. [PMID: 33814374 PMCID: PMC8024134 DOI: 10.17712/nsj.2021.2.20200171] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 01/23/2021] [Indexed: 11/20/2022]
Abstract
Objectives: To present the experience on stroke thrombolysis of a tertiary care center in Riyadh, KSA. Methods: Cross-sectional, observational study of patients thrombolyzed between January 2012 and December 2018. Results: Thrombolysis was performed in 148 patients (mean age: 58.2±14.5 years), 94 (63.5%) of them were men. The median onset-to-door time was 81 minutes, and 25% of the patients arrived within 1 hour. The median National Institute of Health Stroke Scale score upon admission was 13. Hypertension (68.9%), diabetes (56.1%), and dyslipidemia (40.5%) were the most common risk factors for stroke. The most common mechanism of stroke was cardioembolism (43.2%), which was associated with a more severe presentation (p=0.031). Intravenous thrombolysis alone was given to 98 patients (66.2%); the rest received intravenous tissue plasminogen activator plus endovascular therapy or endovascular therapy alone. The median door-to-needle (DTN) time was 70.5 min, with a significant improvement from 2012 (111.6 minutes) to 2018 (69.9 minutes) (p<0.001). Among the patients, 53 (35.8%) showed a good outcome (with a modified Rankin score of 0–2) whereas 14 (9.5%) died. Symptomatic intracranial hemorrhage (sICH) was seen in 8.1%. All vascular risk factors were more common in patients aged >60 years, except smoking, which was more common in the younger age group (p=0.007). Conclusion: In our cohort, the utilization of thrombolysis and the DTN time improved over time. One-thirds of the patients received endovascular treatment. Moreover, the frequency of the vascular risk factors was high. Compared with the published findings, our results showed that cardioembolic strokes were the most frequent and had severe presentation and were likely the cause of the slight increase in mortality and sICH.
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Affiliation(s)
- Ismail A Khatri
- From the Division of Neurology (Khatri, AlSkaini, AlDayel, AlShammari, AlKhalaf, AlRasheed, AlKhathaami, AlOtaibi), Department of Medicine, Department of Nursing (Tarawneh, AlHizan), King Abdulaziz Medical City, Ministry of National Guard Health Affairs, from the College of Medicine (Khatri, Masuadi, AlKhathaami, AlOtaibi), King Saud bin Abdulaziz University for Health Sciences, from King Abdullah International Medical Research Center (Khatri, Masuadi, AlKhathaami, AlOtaibi), from the College of Public Health (AlBoqami), King Saud bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
| | - Mohammed AlSkaini
- From the Division of Neurology (Khatri, AlSkaini, AlDayel, AlShammari, AlKhalaf, AlRasheed, AlKhathaami, AlOtaibi), Department of Medicine, Department of Nursing (Tarawneh, AlHizan), King Abdulaziz Medical City, Ministry of National Guard Health Affairs, from the College of Medicine (Khatri, Masuadi, AlKhathaami, AlOtaibi), King Saud bin Abdulaziz University for Health Sciences, from King Abdullah International Medical Research Center (Khatri, Masuadi, AlKhathaami, AlOtaibi), from the College of Public Health (AlBoqami), King Saud bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
| | - AbdulRahman AlDayel
- From the Division of Neurology (Khatri, AlSkaini, AlDayel, AlShammari, AlKhalaf, AlRasheed, AlKhathaami, AlOtaibi), Department of Medicine, Department of Nursing (Tarawneh, AlHizan), King Abdulaziz Medical City, Ministry of National Guard Health Affairs, from the College of Medicine (Khatri, Masuadi, AlKhathaami, AlOtaibi), King Saud bin Abdulaziz University for Health Sciences, from King Abdullah International Medical Research Center (Khatri, Masuadi, AlKhathaami, AlOtaibi), from the College of Public Health (AlBoqami), King Saud bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
| | - AlBoqami Qamra
- From the Division of Neurology (Khatri, AlSkaini, AlDayel, AlShammari, AlKhalaf, AlRasheed, AlKhathaami, AlOtaibi), Department of Medicine, Department of Nursing (Tarawneh, AlHizan), King Abdulaziz Medical City, Ministry of National Guard Health Affairs, from the College of Medicine (Khatri, Masuadi, AlKhathaami, AlOtaibi), King Saud bin Abdulaziz University for Health Sciences, from King Abdullah International Medical Research Center (Khatri, Masuadi, AlKhathaami, AlOtaibi), from the College of Public Health (AlBoqami), King Saud bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
| | - Emad Masuadi
- From the Division of Neurology (Khatri, AlSkaini, AlDayel, AlShammari, AlKhalaf, AlRasheed, AlKhathaami, AlOtaibi), Department of Medicine, Department of Nursing (Tarawneh, AlHizan), King Abdulaziz Medical City, Ministry of National Guard Health Affairs, from the College of Medicine (Khatri, Masuadi, AlKhathaami, AlOtaibi), King Saud bin Abdulaziz University for Health Sciences, from King Abdullah International Medical Research Center (Khatri, Masuadi, AlKhathaami, AlOtaibi), from the College of Public Health (AlBoqami), King Saud bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
| | - Mufadhi AlShammari
- From the Division of Neurology (Khatri, AlSkaini, AlDayel, AlShammari, AlKhalaf, AlRasheed, AlKhathaami, AlOtaibi), Department of Medicine, Department of Nursing (Tarawneh, AlHizan), King Abdulaziz Medical City, Ministry of National Guard Health Affairs, from the College of Medicine (Khatri, Masuadi, AlKhathaami, AlOtaibi), King Saud bin Abdulaziz University for Health Sciences, from King Abdullah International Medical Research Center (Khatri, Masuadi, AlKhathaami, AlOtaibi), from the College of Public Health (AlBoqami), King Saud bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
| | - Athal AlKhalaf
- From the Division of Neurology (Khatri, AlSkaini, AlDayel, AlShammari, AlKhalaf, AlRasheed, AlKhathaami, AlOtaibi), Department of Medicine, Department of Nursing (Tarawneh, AlHizan), King Abdulaziz Medical City, Ministry of National Guard Health Affairs, from the College of Medicine (Khatri, Masuadi, AlKhathaami, AlOtaibi), King Saud bin Abdulaziz University for Health Sciences, from King Abdullah International Medical Research Center (Khatri, Masuadi, AlKhathaami, AlOtaibi), from the College of Public Health (AlBoqami), King Saud bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
| | - Deema AlRasheed
- From the Division of Neurology (Khatri, AlSkaini, AlDayel, AlShammari, AlKhalaf, AlRasheed, AlKhathaami, AlOtaibi), Department of Medicine, Department of Nursing (Tarawneh, AlHizan), King Abdulaziz Medical City, Ministry of National Guard Health Affairs, from the College of Medicine (Khatri, Masuadi, AlKhathaami, AlOtaibi), King Saud bin Abdulaziz University for Health Sciences, from King Abdullah International Medical Research Center (Khatri, Masuadi, AlKhathaami, AlOtaibi), from the College of Public Health (AlBoqami), King Saud bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
| | - Ali AlKhathaami
- From the Division of Neurology (Khatri, AlSkaini, AlDayel, AlShammari, AlKhalaf, AlRasheed, AlKhathaami, AlOtaibi), Department of Medicine, Department of Nursing (Tarawneh, AlHizan), King Abdulaziz Medical City, Ministry of National Guard Health Affairs, from the College of Medicine (Khatri, Masuadi, AlKhathaami, AlOtaibi), King Saud bin Abdulaziz University for Health Sciences, from King Abdullah International Medical Research Center (Khatri, Masuadi, AlKhathaami, AlOtaibi), from the College of Public Health (AlBoqami), King Saud bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
| | - Nasir AlOtaibi
- From the Division of Neurology (Khatri, AlSkaini, AlDayel, AlShammari, AlKhalaf, AlRasheed, AlKhathaami, AlOtaibi), Department of Medicine, Department of Nursing (Tarawneh, AlHizan), King Abdulaziz Medical City, Ministry of National Guard Health Affairs, from the College of Medicine (Khatri, Masuadi, AlKhathaami, AlOtaibi), King Saud bin Abdulaziz University for Health Sciences, from King Abdullah International Medical Research Center (Khatri, Masuadi, AlKhathaami, AlOtaibi), from the College of Public Health (AlBoqami), King Saud bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
| | - Maisoun Tarawneh
- From the Division of Neurology (Khatri, AlSkaini, AlDayel, AlShammari, AlKhalaf, AlRasheed, AlKhathaami, AlOtaibi), Department of Medicine, Department of Nursing (Tarawneh, AlHizan), King Abdulaziz Medical City, Ministry of National Guard Health Affairs, from the College of Medicine (Khatri, Masuadi, AlKhathaami, AlOtaibi), King Saud bin Abdulaziz University for Health Sciences, from King Abdullah International Medical Research Center (Khatri, Masuadi, AlKhathaami, AlOtaibi), from the College of Public Health (AlBoqami), King Saud bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
| | - Khloud AlHizan
- From the Division of Neurology (Khatri, AlSkaini, AlDayel, AlShammari, AlKhalaf, AlRasheed, AlKhathaami, AlOtaibi), Department of Medicine, Department of Nursing (Tarawneh, AlHizan), King Abdulaziz Medical City, Ministry of National Guard Health Affairs, from the College of Medicine (Khatri, Masuadi, AlKhathaami, AlOtaibi), King Saud bin Abdulaziz University for Health Sciences, from King Abdullah International Medical Research Center (Khatri, Masuadi, AlKhathaami, AlOtaibi), from the College of Public Health (AlBoqami), King Saud bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
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