Thrombolytics in acute ischaemic stroke - A guide to patient selection andoptimum use

Intravenously administered alteplase (recombinant tissue plasminogen activa tor; rtPA) is the only medical treatment that has been approved for the man agement of acute ischaemic stroke. Although rtPA has demonstrated efficacy in improving outcomes of patients with a wide range of neurological impairm ents, it cannot be given with impunity. Thrombolytic therapy is associated with a considerable risk of intracranial bleeding that is likely to be cata strophic. Careful selection of patients to treat and intensive ancillary ca re are the keys for successful administration of rtPA. An algorithm for sel ection is based on the interval from the onset of stroke, history of recent medical illnesses or use of medications, findings of the medical and neuro logical examinations and the results of laboratory and brain imaging studie s. Because rtPA must be given within 3 hours of onset of stroke, most patie nts cannot be treated. Thus, additional therapies are needed for treatment of patients with acute ischaemic stroke.