Thrombolysis in Acute Ischaemic Stroke: A Retrospective Audit of the Role of Alteplase in Hyperacute Stroke Management

ObjectivesThis study aimed to investigate the factors contributing to the low thrombolysis rates for acute ischemic stroke at Eastbourne District General Hospital and to formulate evidence-based recommendations to improve timely access to thrombolytic treatment. MethodsA retrospective audit was conducted on stroke admissions during April–May 2019 and 2020. Patient records were analyzed to assess eligibility for thrombolysis, time of presentation, imaging timelines, and treatment decisions. Comparisons were drawn between in-hours and out-of-hours presentations using descriptive and inferential statistics. ResultsAmong 395 suspected stroke cases, 185 thrombolysis alerts were initiated, yet only 21 patients (7.3%) received Alteplase. The majority of these treatments occurred outside of regular hours. Key barriers included delayed door-to-needle times and incomplete pre-alert notifications. Median door-to-needle times frequently exceeded 60 minutes, indicating systemic inefficiencies. ConclusionTo enhance thrombolysis rates, comprehensive improvements across the stroke care pathway are necessary. These include raising public awareness, streamlining in-hospital procedures, ensuring consistent medical staffing, and exploring the use of faster-acting thrombolytic agents such as Tenecteplase.