Use of Thrombolytics for the Management of Acute Ischemic Stroke in the Emergency Department

Publication Date: September 26, 2024
Last Updated: September 27, 2024

Summary of Recommendations

In stroke patients who are candidates for both mechanical thrombectomy and IVT*, IVT should be offered and may be given prior to mechanical thrombectomy. (B)

*IVT is given within 4.5 hours from symptom onset

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When feasible, shared decision making between the patient (and/or their surrogate) and a member of the health care team should include a discussion of potential benefits and harms prior to the decision whether to administer intravenous thrombolytics. (C)
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Recommendation Grading

Disclaimer

The information in this patient summary should not be used as a substitute for professional medical care or advice. Contact a health care provider if you have questions about your health.

Overview

Title

Use of Thrombolytics for the Management of Acute Ischemic Stroke in the Emergency Department

Authoring Organization

American College of Emergency Physicians

Publication Month/Year

September 26, 2024

Last Updated Month/Year

September 27, 2024

Document Type

Guideline

Country of Publication

US

Document Objectives

This clinical policy from the American College of Emergency Physicians is the revision of a clinical policy approved in 2015 addressing a critical question regarding the use of thrombolytics for the management of acute ischemic stroke. A writing committee conducted a systematic review of the literature to derive evidence based recommendations to answer the following clinical question: In adult stroke patients who are a candidate for mechanical thrombectomy, is the use of intravenous thrombolysis prior to mechanical thrombectomy (Bridge therapy) beneficial and safe versus mechanical thrombectomy alone? Evidence was graded, and recommendations were made based on the strength of the available data.

Target Patient Population

Adult patients aged 18 years and older presenting to the ED with acute ischemic stroke.

Target Provider Population

Physicians working in emergency departments (EDs).

Inclusion Criteria

Male, Female, Adolescent, Older adult

Health Care Settings

Emergency care, Hospital

Intended Users

Nurse, nurse practitioner, physician, physician assistant

Scope

Treatment, Management

Diseases/Conditions (MeSH)

D015912 - Thrombolytic Therapy, D000083242 - Ischemic Stroke

Keywords

stroke, Acute Ischemic Stroke, Emergency Department, Thrombolytics