Abstract / Summary
Background: Acute ischemic stroke (AIS) is a predominant cause of death and prolonged disability, globally. Intravenous alteplase (tPA) is the mainstay treatment when administered within therapeutic timeframe. In low and middle-income countries like Pakistan, treatment delays frequently stem from insufficient awareness among healthcare professionals. This study evaluated the knowledge, attitudes, and behaviors of postgraduate residents at public and private hospitals of Khyber Pakhtunkhwa regarding the use of intravenous alteplase in the management of acute ischemic stroke. Methods: A cross-sectional study was conducted from January to June 2025 among 206 postgraduate residents from various public and private-sector hospitals of Khyber Pakhtunkhwa using a validated questionnaire adapted from Al Khathaami et al. Knowledge was evaluated using three fundamental criteria (effectiveness, standard of treatment, recommendation), resulting in a Knowledge Score from 0-3. Statistical investigations included t-tests, one-way ANOVA with post-hoc evaluations, and multivariable linear regression to identify the determinants of knowledge. Results: The average Knowledge Level Score was 2.81 ± 0.63, with 89.8% of individuals attaining the highest level. No notable differences were detected between inhabitants of public and private institutions (p = 0.882) or among residency years (p = 0.234). Multivariable regression indicated no significant determinants of knowledge (R² = 0.009, p = 0.880). Notwithstanding robust foundational knowledge, 10% of participants exhibited hesitance in endorsing tPA, attributing their reservations to worries over bleeding (52.9%), insufficient experience (35.0%), and medico-legal implications (3.4%). Notably, 86.4% indicated a readiness to pursue additional training, while 72.3% endorsed tele-stroke consulting methods. Conclusion: Postgraduate residents in Khyber Pakhtunkhwa exhibit substantial basic knowledge of intravenous alteplase in acute ischemic stroke, regardless of training year or type of institution. Obstacles to implementation originate from attitudes, self-assurance, and medico-legal issues.