IVT: intravenous thrombolysis; NCCT: noncontrast computed tomography; MRI: magnetic resonance imaging; DWI: diffusion-weighted MRI; FLAIR: fluid-attenuated inversion recovery; CT: computed tomography; CTP: CT perfusion; PWI: perfusion-weighted MRI; CTA: CT angiogram; SBP: systolic blood pressure; DBP: diastolic blood pressure; INR: international normalized ratio; aPTT: activated partial thromboplastin time; DOAC: direct oral anticoagulant; LMWH: low molecular weight heparin; VTE: venous thromboembolism.
* An MRI mismatch, defined by an acute ischemic brain lesion detected on DWI but no corresponding hyperintensity on FLAIR (diffusion positive and FLAIR negative), correlates with a stroke onset time of 4.5 hours or less, and therefore with IVT eligibility.
¶ Automated perfusion imaging reveals an ischemic core with a larger penumbra of hypoperfused but viable brain tissue.
Δ Refer to UpToDate content on mechanical thrombectomy for acute ischemic stroke.
◊ IVT should NOT be delayed while coagulation tests are pending unless (1) there is clinical suspicion of a bleeding abnormality or thrombocytopenia, (2) the patient is currently on or has recently received anticoagulants (eg, heparin, warfarin, DOAC), or (3) use of anticoagulants is not known. Otherwise, treatment with IVT can be started before availability of coagulation test results.
§ Platelet count should be checked only if there is clinical suspicion for thrombocytopenia.
¥ Patients may be treated with IVT if glucose level is subsequently normalized without reversal of neurologic deficit.Do you want to add Medilib to your home screen?