Emergency Department Management of Postthrombolysis Intracranial Hemorrhage

Points & Pearls Excerpt

• Rates of symptomatic intracranial hemorrhage (ICH) after intravenous (IV) thrombolysis for stroke range from 2% to 7%.⁹
• Symptomatic ICH following IV thrombolytic therapy most commonly occurs within 12 hours of administration; many patients remain in the emergency department during this period, making structured neurological monitoring essential.^7,8
• Alteplase requires an infusion due to its short half-life (3-5 minutes), while tenecteplase allows bolus administration due to its longer half-life (20-25 minutes). (See Figure 1.)^1,2,14
• A 2025 meta-analysis found no significant difference in rates of symptomatic ICH between patients receiving tenecteplase versus those receiving alteplase (3.1% vs 2.5%).⁸