Abstract 12134: The Utilization Rate of Intravenous Thrombolysis in Asian Countries: A Systematic Review and Meta-Analysis

Introduction: Even though IV thrombolysis has been used for more than two decades, coverage remains inadequate. Asia, the region with the highest age-standardized incidence of ischemic stroke, has no regional data on IVT utilization at present.

Objective: This study aimed to provide more accurate estimates of IVT usage for AIS in Asia.

Methods: We performed a systematic literature search using PubMed, Embase, and Scopus for relevant articles from inception until 15th March 2023.

Results: A total of 67 observational studies with a total of 778,046 patients with ischemic stroke were included in the final analysis. In terms of regional distribution of studies, East Asia was the most common (n=12), followed closely by Arab (n=18), Southeast Asia (n=15), South Asia (n=12) and lastly Central and North Asia (n=2). In terms of the income level stratified by GDP of these countries, 35.8 % of them were classified as high-income countries, 40.3% were of lower-middle income countries and the rest (23.9%) being upper-middle-income countries. Our pooled analysis of 67 Asian studies revealed an IV thrombolysis rate of 9.1%. We discovered substantial variation in the thrombolysis rate across Asia, with 11.3% receiving thrombolysis in HIC countries and only 8.1% in LMICs; far below the American Stroke Association's target rate of 50%.

Conclusion: Patients with ischemic stroke in HIC countries, countries/hospitals with their own guidelines/protocols, living in urban areas, and receiving care in hospitals with a public-private partnership are more likely to receive thrombolysis, according to our findings. Improving thrombolysis rates throughout Asia would be greatly aided by reducing prehospital and hospital delays, enhancing local infrastructure and human resources, and educating the public about stroke.