The decision to treat with thrombolysis and/or thrombectomy should be based on an individual assessment of the patient’s likely benefits and risks.
- The benefits are a reduced likelihood of having persisting deficits which will disable the patient
- The risks of thrombolysis have been described in the hyperacute stroke treatments module: 01 Hyperacute stroke treatments including thrombolysis and thrombectomy: Case: 3 Angela
- The risks of thrombectomy have been described in the hyperacute stroke treatments module: 01 Hyperacute stroke treatments including thrombolysis and thrombectomy: Case: 4 Iain
- Most conservatively you might apply strictly the eligibility criteria in the alteplase datasheet. However, relatively few patients will fulfil these.
- The American Heart Association guidelines include a fairly exhaustive list of recommendations regarding the eligibility for treatment with iv thrombolysis, but leaves many judgements to be made by the physician treating the individual patients. See table.
- Many physicians treat patients who do not strictly meet all the criteria. They might treat a patient who has several very favourable factors e.g. very short delay since onset, no uncertainty about diagnosis, young age but has some relative contraindication e.g. operation one month before.
- Clinicians need to weigh up the relative importance of each factor and then taking account of the patient’s, or their family’s, views to reach a final decision about whether to offer thrombolysis and/or thrombectomy or not.
