Utilization Trends and Outcomes of Alteplase in Acute Cerebral Ischemia among Patients with Hypertension or Diabetes: A Tertiary Care Experience from Southern Punjab.

objectivesStroke is the second leading cause of death and the third leading cause of disability worldwide, with hypertension and diabetes mellitus being its most prominent risk factors. This study aims to assess the utilization trends and clinical outcomes of Alteplase in patients presenting with acute cerebral ischemia and known history of hypertension and/or diabetes, within our local population in Southern Punjab, Pakistan-a region with limited stroke care infrastructure.

methodsThis observational study was conducted at the emergency department of a tertiary care hospital. A total of 106 patients presenting with acute cerebral ischemia confirmed via CT scan and/or MRI were enrolled. All patients had a documented history of hypertension (n = 91), diabetes mellitus (n = 27), or both (n = 64). Patients who presented within 4.5 hours of symptom onset and met standard inclusion criteria were administered intravenous Alteplase as per AHA/ ASA guidelines. Patients were divided into two groups: Group 1 (received Alteplase, n = 56) and Group 2 (did not receive Alteplase, n = 82). Outcomes were measured using the modified Rankin Scale (mRS) at 3 months post-intervention, with favorable recovery defined as mRS 0-2.

resultsOf the 44 patients who received Alteplase, 66% (n = 37) achieved favorable outcomes (mRS 0-2). In contrast, only 39% (n = 32) of the 62 patients in the non-Alteplase group had favorable recovery. No significant increase in hemorrhagic complications was observed in the Alteplase group. DISCUSSION: The findings in this study are consistent with international evidence demonstrating the safety and efficacy of intravenous thrombolysis in carefully selected patients, including those with vascular comorbidities such as hypertension and diabetes. In our study, most patients were treated late due to limited stroke units and long travel times, reflecting barriers in Pakistan's healthcare system. The mean age of stroke was 52 years, which is younger than that reported in Western populations, and men were more frequently affected, in contrast to existing literature that shows a higher prevalence in women. Left hemisphere involvement predominated. Hypertension and diabetes were universal risk factors, underscoring their role in stroke burden. Overall, timely Alteplase therapy remains crucial, highlighting the need for improved infrastructure and early intervention strategies. The improved functional outcomes observed in our cohort reinforce the need for early recognition, rapid triage, and timely administration of Alteplase. However, limited availability of specialized stroke units, delayed hospital presentations, and lack of trained personnel continue to hinder widespread implementation of thrombolytic therapy in lowresource settings like Southern Punjab.

conclusionIn patients with acute cerebral ischemia and pre-existing hypertension or diabetes, the timely administration of Alteplase significantly improves functional outcomes. Despite its proven efficacy, access to thrombolytic therapy remains inadequate in public sector hospitals in Southern Punjab. Efforts must be made to expand stroke services and standardize acute stroke care across the region.