In this section : Stroke and TIA
Management of Hypertension in Acute Stroke
Stroke Care
Stroke – Post Thrombolysis
Stroke Thrombolysis
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Stroke Thrombolysis
Last updated 5th August 2024
Stroke Thrombolysis Pathway
Patient Flow
- If thrombolysis commenced
- Monday – Friday 0800 – 1600 transfer patient to Acute Stroke Unit (Ward D7)
- Stroke Team, Bed Managers, Ward D7 Nurse in Charge will look at ALL options to facilitate transfer to D7 and if none available then patient should go to CCU
- 1600 onwards, OOH & Weekends – Transfer patient to CCU
- If patient NOT thrombolysed, seek transfer to D7 or CAU based on bed availability
Contacts
- Stroke Team – Monday-Friday 0800 – 1700 – Dr Ritesh Malik Ext 32191, Dr Amy Conley Ext 33180, Stroke Specialist Nurse Ext 32065
- Out of Hours – QEUH, Glasgow Tel 0141 452 3234
Exclusion Criteria
Absolute
- Systolic BP >185mmHg or diastolic BP >110 mmHg at time of treatment (BP can be treated prior to treatment as per guidance)
- Platelet count below 100,000/mm3
- On oral anticoagulants e.g. warfarin INR >1.6
- On DOAC request assay test if level above 25ng/dl then DOAC in circulation & not for thrombolysis. Takes about 1 hour to process to need to consider onset time to delivery of bolus.
- Seizure at onset of stroke (to exclude Todd’s paralysis)
- Blood glucose <2.8mmol/L (to exclude focal deficit due to abnormal glucose)
- Fully resolved symptoms and no recurrence
Relative
- On Heparin/LMWH within the previous 48 hours and APTT still raised
- Known haemorrhagic retinopathy e.g. in diabetes
- Prior stroke or head injury within the last 3 months
- Alcohol or drug intoxication, or history of significant substance abuse
- History suggestive of subarachnoid haemorrhage
- Known CNS vascular malformation, aneurysm or tumour
- Known bacterial endocarditis or pericarditis
- GI or urinary bleeding within last 21 days
- Pregnant
- Peritoneal or haemodialysis
- Neoplasm with increased bleeding risk
- Known acute pancreatitis
- Known severe liver disease (hepatic failure, cirrhosis, varices, active hepatitis etc.)
- Recent (less than 10 days) traumatic external heart massage, obstetrical delivery, recent puncture of non-compressible blood vessel (e.g. subclavian or jugular vein), liver or kidney biopsy thoracocentesis & lumbar puncture et.c within 10 days
- Major surgery or signficant trauma in past 21 days
- Known allergy/sensitivity to alteplase
Links
Content by Dr Ritesh Malik