Current Status of Stroke Thrombolysis in the Mission Thrombectomy 2020+ Caribbean Region.

Background: Low- to middle-income countries have limited access to thrombolytic therapy. To our knowledge, there is no validated tool available to objectively measure access to thrombolytic agents or barriers to routine clinical use. Methods: We developed the 17-item tissue plasminogen activator Spot Check tool to assess usage of acute stroke thrombolysis regarding local experience, financial constraints, and perceived barriers to care; evaluating the current state of clinical practices in the Mission Thrombectomy 2020+ Caribbean region. The survey was disseminated via an online link, and the information was collected and analyzed via SPSS. Results: The tool was validated by 3 international experts with an Average Content Validity Index of 1 and a Universal Agreement Index of 1 across 3 domains: local experience, financial constraints, and barriers to usage. The participant survey response rate was 64%, representing 15 of 44 Mission Thrombectomy 2020+ Caribbean countries. There was limited or no access to thrombolytic agents in 40% of countries surveyed. Among cases treated with thrombolytics, 43% of patients had to pay out of pocket before treatment was provided, and l<10% were covered by insurance/government. Among 51% of countries surveyed, no acute thrombolytic treatment was provided for acute stroke in the 2021 calendar year. Only 1 center treated >100 cases per year. Most respondents (88%) agreed there were barriers to acute stroke thrombolysis in the region. The tissue plasminogen activator Spot Check tool was able to identify barriers impacting the number of cases per year, including absence of stroke protocol (P<0.001), upfront cost of alteplase (P = 0.003), restricted the amount of thrombolytics (P = 0.002), neurology intensive care unit or stroke unit monitoring of patients following thrombolytics (P = 0.017), cost of thrombolytic agents to the hospital (P = 0.042), and access to computed tomography scan (P = 0.03). Conclusion: This survey brings light to an enormous disparity in the care of stroke patients around the world, specifically in the Mission Thrombectomy 2020+ Caribbean region.