Acute evaluation and management of ischemic stroke-1

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Thrombolytic and Antithrombotic therapy

Timely restoration

of blood flow is the most effective maneuver for salvaging ischemic brain tissue that is not already infarcted. The major questions are:
  • When

    is recanalization too late to salvage brain tissue ?

  • When is the use of thrombolytic agents, which increase the risk of brain hemorrhage, too dangerous ?

Intravenous thrombolysis - the only therapy currently approved by the FDA for acute stroke is intravenous recombinant tissue-plas minogen activator (rt-PA), which was shown to be effective in improving functional outcome at three months if given within three hours of symptom onset. The data supporting this recommendation come from the NINDS (National Institute of Neurological Disorders and Stroke) rt-PA stroke study.

Other trials which randomized patients with six hours of symptom onset showed no benefit from thrombolytic therapy.

The most feared complication of rt-PA administration is symptomatic brain hemorrhage, usually into the infarcted area.

Whether to proceed to thrombolysis in an individual patient should be based upon a discussion about the risks and benefits with the patient and family.

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