Intravenous Thrombolysis in Acute Ischemic Stroke
July 17, 2019
Posted by Andy Jagoda, MD in: Feature Update , trackback
Stroke is the fifth leading cause of death in the United States and an important cause of long-term disability. Approximately 795,000 people suffer from stroke each year (610,000 primary strokes and 185,000 recurrent strokes),1 with ischemic stroke representing the vast majority of all stroke types (87%).
The cornerstone of acute ischemic stroke treatment relies on rapid clearance of an offending thrombus in the cerebrovascular system. Advanced neuroimaging and clinical trials, together with continuous adjustments of inclusion/exclusion criteria, have helped emergency clinicians to rapidly and more accurately identify the patients who will benefit from acute stroke treatment.
Inclusion and Exclusion of Intravenous Thrombolysis: A Changing Landscape
The American Heart Association (AHA) recently published updated guidelines for stroke management. Table 1, summarizes the updated 2018 AHA indications and contraindications for treatment with IVT. Every patient presenting with symptoms of acute stroke within 4.5 hours of last known well or usual state should be triaged for potential IVT. Patients should be evaluated with computed tomography (CT) scan of the brain and systolic blood pressure (SBP) should be maintained at < 185 mm Hg and diastolic blood pressure (DBP) at < 110 mm Hg. Every eligible patient should receive IVT without delay. Changes and adjustments of inclusion/exclusion criteria (in order to minimize the risk of any complication) have been made and are discussed in following sections.
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