Abstract Details

Title Implementing Code Stroke and Thrombolysis in the Dominican Republic: A Pilot Study of Barriers, Outcomes, and Public Health Lessons

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P8 - Poster Session 8 (11:45 AM-12:45 PM)

Poster/Presentation
Number 5-018

Objective To evaluate outcomes, safety and implementation barriers of thrombolysis in patients with acute ischemic stroke (AIS) at two public hospitals designated as Pilot Stroke Centers.

Background Intravenous Thrombolysis (IVT) is the standard of care for patients with AIS when administered within 4.5 hours of stroke onset. The rate of thrombolysis in low-middle-income countries (LMIC) is less than 2%. The benefits of thrombolysis are time dependent, and earlier treatment is associated with better outcomes.

Design/Methods Retrospective Review

Results Seventeen patients received IVT; 76% were male and 76% were between 51–79 years. Hypertension was the most common risk factor (65%), followed by congestive heart failure (35%) and diabetes mellitus (18%). Most patients arrived by ambulance (59%), and all underwent computed tomography. Thrombolysis metrics such as door to neurology evaluation, door to CT scan and door to needle were assessed, obtaining a median of 40, 31 and 107 minutes respectively. Mean NIHSS decreased from 16 on admission (SD: 6.51; 95% CI: 12.43–19.33) to a median of 8 at discharge (IQR:12; 95% CI: 12.43–13.08), showing significant improvement (p = 0.011). Median mRS on admission increased from 0 (IQR: 0–0.62) to 3 (IQR: 2.11–4.01) at discharge (p < 0.05). Median hospital stay was 6 days (IQR: 3–8). Reported barriers included lack of prenotification, prolong time to neurology consultation, lack of expertise on thrombolytic mixing and materials to complete infusion.

Conclusions

This pilot program represents the first initiative of its kind in the Caribbean, offering evidence-based, real-life experience of treatment implementation of acute ischemic stroke in the Dominican Republic. There was a statistically significant reduction of NIHSS between admission and discharge. Thrombolysis implementation not only demonstrates feasibility but also highlights the potential for broader adoption and foundation for future implementation in LMIC.

Authors/Disclosures
Ryna Then, MD (Jefferson Einstein Hospital) PRESENTER	Dr. Then has nothing to disclose.
Cristina E. Ramos, MD	Dr. Ramos has nothing to disclose.
Vifranny A. Espaillat Duran, MBBS	Dr. Espaillat Duran has nothing to disclose.
Maria G. Munoz, Br	Mrs. Munoz has nothing to disclose.
Marcos M. Mota, Sr., Br	Mr. Mota has nothing to disclose.
Genesis Polanco Jerez, MD (Hospital José Maria Cabral y Baez)	Dr. Polanco Jerez has nothing to disclose.
Raquel Monegro Cordero, Estudiante	Mrs. Monegro Cordero has nothing to disclose.
Henry L. Alvarez, MD	Dr. Alvarez has nothing to disclose.
Dorisbel A. Grullon, Sr., MD	Dr. Grullon has nothing to disclose.
Carelyn Gonzalez, Sr., MD	Dr. Gonzalez has nothing to disclose.
Ramon A. Gonzalez, MD	Dr. Gonzalez has nothing to disclose.
Jamila Y. Mercedes, Jr., MD	Dr. Mercedes has nothing to disclose.
Yaritza Bautista Estrella, PhD	Dr. Bautista Estrella has nothing to disclose.
Mariela Madera, MD	Dr. Madera has nothing to disclose.
Alvi Vargas, Jr., MD	Dr. Vargas has nothing to disclose.
Michele Hernandez, MD	Dr. Hernandez has nothing to disclose.
Rosa Elba Medina, Sr., MBBS	Rosa Elba Medina has nothing to disclose.
Madelein Gomez, MD	Dr. Gomez has nothing to disclose.
Enoch De los Rios, MD	Mr. De los Rios has nothing to disclose.
Abigail Jean, MD	Dr. Jean has received personal compensation for serving as an employee of Servicio Nacional de Salud .
Rosa I. Cheas Guerrero, MD	Ms. Cheas Guerrero has nothing to disclose.
Genesis L. Mendez, Sr., MD	Dr. Mendez has nothing to disclose.
Marielba Cáceres Lora	Dr. Cáceres Lora has nothing to disclose.
Luis M. Gutierrez Vasquez, MD	Dr. Gutierrez Vasquez has nothing to disclose.
Jirandy J. Perez, MD	Dr. Perez has nothing to disclose.
Karolin S. Castro, MD	Dr. Castro has nothing to disclose.
NELCIDY M. MORONTA BAEZ, MD	Dr. MORONTA BAEZ has nothing to disclose.
Minelly Rodriguez Severino, MD, FAAN (Hospital Gautier)	Dr. Rodriguez Severino has nothing to disclose.
Luis Tusen, MD	Dr. Tusen has nothing to disclose.
Yvan Mercader, MD (Clinica Dr.Bonilla)	Dr. Mercader has nothing to disclose.
Bruno A. Rosario, MD (Union Medica del Norte)	Dr. Rosario has nothing to disclose.
Andelys V. De La Rosa, PhD	Dr. De La Rosa has nothing to disclose.

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