# Intravenous Thrombolysis Administration Rate in Patients With Ischemic Stroke at a Tertiary Private Hospital in Mexico City

## TL;DR

This study examines how often stroke patients in a Mexican hospital receive a clot-busting treatment and finds that while rates are better than national averages, delays in care remain a problem.

## Contribution

The paper provides a detailed analysis of thrombolysis rates and associated factors in a private tertiary hospital in Mexico City, highlighting actionable insights for improving stroke care in middle-income countries.

## Key findings

- Only 21.4% of ischemic stroke patients received intravenous thrombolysis, despite 46% of eligible patients arriving within 4.5 hours.
- Shorter door-to-CT and door-to-needle times were rare, indicating significant delays in treatment initiation.
- Stroke severity and early arrival were strongly associated with higher thrombolysis rates.

## Abstract

Introduction: Ischemic stroke is a major cause of morbidity and mortality in Mexico; however, national intravenous thrombolysis rates remain low compared to international standards.

Objective: To evaluate the rate of intravenous thrombolysis in ischemic stroke patients at a private tertiary hospital in Mexico City and to identify clinical and organizational factors associated with treatment delivery.

Methods: We conducted an observational, retrospective, single-center study including 182 ischemic stroke patients admitted between 2021 and 2023. Demographic, clinical, and imaging data were extracted from medical records. Stroke severity was assessed using the NIHSS. Reperfusion therapies, treatment times (door-to-computed tomography [CT], door-to-needle, and door-to-groin), and reasons for exclusion from thrombolysis were documented. Bivariate and multivariate analyses were performed to identify predictors of thrombolysis.

Results: The mean age was 69.5 years, and 52% (n=95) were men. Hypertension (49.5%, n=90), diabetes (21.4%, n=39), and dyslipidemia (14.3%, n=26) were the most frequent comorbidities. Overall, 39 patients (21.4%) received intravenous thrombolysis, including 13 who also underwent mechanical thrombectomy. Among patients who arrived within 4.5 hours of symptom onset (n=85), 46% (n=39) received thrombolysis; of these, 33 (39% of early arrivers) were treated strictly within the conventional 4.5-hour window. Stroke severity (NIHSS ≥5), anterior circulation involvement, early arrival (<1 hour), concomitant thrombectomy, and shorter door-to-groin times were significantly associated with higher thrombolysis rates. Age, sex, and comorbidities showed no significant association. Only 18% (n=33) of patients achieved a door-to-CT time <25 minutes, 21% (n=38) a door-to-needle time <60 minutes, and 11% (n=20) a door-to-groin time <120 minutes. Hemorrhagic transformation occurred in 20% (n=36), and in-hospital mortality was 9% (n=16), aligning with international registry data.

Conclusions: The thrombolysis rate observed at this tertiary private hospital was higher than national averages, likely due to early recognition of symptoms, access to extended window protocols, and availability of specialized stroke care. Nonetheless, treatment delays remain a significant challenge. Strengthening institutional stroke pathways and reducing door-to-treatment times are key priorities. Broader implementation of streamlined protocols and prehospital notification systems could improve stroke care delivery in middle-income countries like Mexico.