Stroke

  • A stroke occurs when blood flow to a part of the brain is interrupted, leading to brain cells necrosis. It can be ischemic (due to a blood clot) or hemorrhagic (due to a ruptured blood vessel).

Acute Ischemic Stroke

  • Intravenous tPA (alteplase) should be administered within 4.5 hours of symptom onset for optimal benefit. Administration beyond this time window increases the risk of complications, particularly hemorrhage.
  • Blood pressure must be controlled to below 185/110 mmHg before initiating tPA therapy to reduce the risk of intracerebral hemorrhage.

Contraindications for thrombolysis

  1. Mild nondisabling stroke (NIHSS score 0–5)
  2. Acute intracranial hemorrhage
  3. Ischemic stroke within 3 months
  4. Severe head trauma within 3 months
  5. Acute head trauma
  6. Intracranial/intraspinal surgery within 3 months
  7. History of intracranial hemorrhage
  8. GI malignancy or GI bleed within 21 days
  9. Coagulopathy
  10. On anticoagulants (LMWH or DOACs)
  11. Infective endocarditis
  12. Aortic arch dissection
  13. Intra-axial intracranial neoplasm

Complications of thrombolysis

  • Hemorrhagic Transformation is known complication of thrombolytic therapy, particularly in cases with large infarctions or delayed treatment.