Assessing Outcome of tPA Therapy in Patients with Acute Ischemic Stroke (0-three hours)

Abstract

Objective: To determine the frequency of good functional outcome and significant neurological improvement for patients treated with tPA within first three hours of onset of acute ischemic stroke.

Methodology: This cross-sectional study was conducted at Neurology Department, Services Hospital, Lahore, from October 2024 to April 2025. Total 51 patients with acute ischemic stroke who received tPA within three hours of symptom onset were included. Neurological improvement was assessed using NIHSS, and functional outcome with Modified Rankin Scale at baseline and after 90 days; ≥4-point improvement in NIHSS was considered as significant neurological improvement, while mRS scores of 0-2 indicated good functional outcome. Data were analyzed using SPSS v26.

Results: Mean NIHSS score improved from 12.31 ± 5.42 at baseline to 7.96 ± 7.05 at 90 days (p < 0.001), while mean mRS improved from 4.02 ± 1.04 to 2.90 ± 1.81 (p < 0.001). Significant neurological improvement was seen in 54.9% of patients, and 49.0% achieved good functional outcomes. No statistically significant associations were found between gender, age, time of tPA administration, or stroke subtype and outcomes (p > 0.05).

Conclusion: These findings suggest that while intravenous tPA therapy led to meaningful neurological and functional improvement in many patients, baseline demographics and time to tPA administration within the three-hour window did not significantly influence the likelihood of achieving favourable outcomes.