What is an indication for thrombolytic therapy?

Answer 1

Criteria for Acute Thrombolytic Therapy

Criteria adapted in accordance with the criteria identified in National Institute of Neurological Disorders and Stroke (NINDS) 233 tPA Stroke Study and the European Cooperative Acute Stroke Study (ECASS III) 207

Treatment Criteria

 Diagnosis of ischemic stroke causing measurable neurologic deficit in a patient who is18 years of age or older  Onset of symptoms more than one hour and less than 4.5 hours before alteplase administration

Exclusion Criteria

Historical

 History of intracranial hemorrhage  Stroke or serious head or spinal trauma in the preceding three months  Recent major surgery  Arterial puncture at a non-compressible site in the previous seven days  Any other condition that could increase the risk of hemorrhage after alteplase administration

Clinical

 Symptoms suggestive of subarachnoid hemorrhage  Stroke symptoms due to another non-ischemic acute neurological condition such as seizure with post-ictal

Todd's paralysis or focal neurological signs due to severe hypo- or hyperglycemia  Hypertension refractory to antihypertensives such that target blood pressure <185/110 cannot be achieved

Laboratory

 Blood glucose concentration below 2.7 mmol/L or above 22.2 mmol/L  Elevated activated partial-thromboplastin time  International Normalized Ratio greater than 1.7  Platelet count below 100,000 per cubic millimetre

CT or MRI Findings

 Any hemorrhage on brain CT or MRI  CT or MRI signs of acute hemispheric infarction involving more than one-third of the middle cerebral artery

territory (Alberta Stroke Program Early CT Score (ASPECTS)<5)