Success rate and determinants of intravenous thrombolysis in acute ischemic stroke from the Malaysia National Stroke Registry

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.

Approval to publish this study was kindly granted by the Director-General of Health Malaysia. Appreciation is also extended to the National Stroke Registry (NSR) and both participating hospitals teams for their contribution to data collection and management. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Department of Public Health Medicine, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh, Selangor, Malaysia Nur Syazmin Sies, Aimi Nadira Mat Ruzlin & Xin Wee Chen Hospital Sultanah Nur Zahirah, Ministry of Health, Kuala Terengganu, Terengganu, Malaysia Norsima Nazifah Sidek & Khairul Azmi Ibrahim Hospital Umum Sarawak, Ministry of Health, Kuching, Sarawak, Malaysia Clinical Research Centre, Ministry of Health, Hospital Umum Sarawak, Kuching, Sarawak, Malaysia Correspondence to Aimi Nadira Mat Ruzlin. The authors declare no competing interests. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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