Abstract / Summary
Abstract Intravenous thrombolysis (IVT) is an established intervention for acute ischemic stroke (AIS), yet comprehensive real-world evidence on its success rate and determinants in low and middle countries (LMCs) remains limited. This retrospective cohort study aimed to determine the success rate of IVT and identify key determinants using data from the Malaysian National Stroke Registry (2014–2023) from two tertiary hospitals. Successful IVT was defined as a National Institutes of Health Stroke Scale (NIHSS) score of ≤ 4 at 24 h post-IVT. Individual-related, clinical-related, and treatment-related determinants were included as the independent variables. Multiple logistic regression was used to identify the determinants of successful IVT. A total of 1,011 eligible patients were included in the study with a median (IQR) age of 62.0 (19.0) years and 61.3% were males. The success rate of IVT was 37.8% (95% CI 34.8–40.8), with median onset-to-needle time of 192.0 (95.0) minutes. Younger age (adjusted odds ratio (aOR) 0.99 (95% CI 0.98–0.99)), lower baseline NIHSS score (aOR 0.87 (95% CI 0.84–0.89)), and small vessel occlusion subtype (aOR 2.52 (95% CI 1.65–3.86)) were significant determinants of successful IVT. These findings highlight important determinants that may help optimize IVT delivery and improve stroke outcomes in Malaysia.