ArticleAfrican journal of emergency medicine : Revue africaine de la medecine d'urgence2026
Barriers to thrombolysis in acute ischaemic stroke: an epidemiological review from a tertiary hospital in the Eastern Cape, South Africa.
Article in African journal of emergency medicine : Revue africaine de la medecine d'urgence, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Introduction: Stroke is one of the leading causes of morbidity and mortality globally, with a significant impact on health systems. In South Africa, especially the Eastern Cape, the epidemiology of acute stroke and the barriers to optimal care remain poorly described. Methods: This retrospective cohort study included adult patients (≥18 years) presenting with acute stroke at a hospital in Gqeberha, Eastern Cape, from 1 July 2019 to 30 June 2020. Results: A total of 403 patients met the inclusion criteria, with 38 excluded from time-based analysis. The median patient age was 60.4 years (IQR 51.6 - 70.6); 54 % were female. Most patients (56 %) arrived via private transport, and 58 % had radiological evidence of an ischaemic stroke. Common stroke risk factors included hypertension, diabetes, and smoking. The median time from symptom onset to hospital presentation was 06 h and 30 min; with 9 % of patients presenting with a wake-up stroke. The median door-to-doctor time was 52 min with 51.8 % seen within 60 min. The median door-to-CT time was 5 h 7 min. A higher proportion of imaging occurred after hours. 99 patients presented within the 4.5-hour thrombolytic window (hyperacute stroke). Of these, 32 had radiological evidence of an intracranial haemorrhage. In the hyperacute stroke cohort, the median door-to-doctor and door-to-CT times were shorter: 25 min and 2 h 19 min respectively. Of those with ischaemic stroke, 35 % were excluded from thrombolysis due to time related factors, 34 % had contraindications, and 31 % were not offered treatment due to clinical and physician related factors. No patients admitted via the emergency department received thrombolysis. None of the national or international time-based quality metrics for acute stroke care were met. Conclusion: This study provides valuable insights into the region's stroke epidemiology and identifies areas for improvement for acute stroke care.
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