Insights

Post-Thrombolysis Hospital Care: Evidence-Based Updates Care following intravenous thrombolysis (IVT) is critical to ensure safety, monitor for complications, and begin secondary prevention. Recent trials have reshaped traditional practices. Below is an overview of updated standards, supported by modern evidence. 🔹 Bottom Line: Post-Thrombolysis Care Blood Pressure: Target <180 mmHg remains standard. Early Mobilization: AVERT…

Adjuvant Therapies in Acute Stroke Despite the success of tPA and endovascular therapy, many patients do not achieve full reperfusion or functional recovery. Investigators have explored adjunctive treatments aimed at improving outcomes when added to standard thrombolysis. These fall into three main categories: antiplatelets, neuroprotectives, and sonothrombolysis (microbubbles). 🔹 Bottom Line: Adjuvants Therapy Aspirin:…

Alternative Thrombolytics in Stroke: TNK, Reteplase, and Intra-Arterial Approaches While intravenous alteplase remains the standard thrombolytic for acute ischemic stroke, several trials now support alternative agents and delivery strategies. This review highlights key studies investigating tenecteplase (TNK), reteplase, and intra-arterial (IA) thrombolysis following thrombectomy. Tenecteplase (TNK) Tenecteplase is a genetically engineered alteplase variant with…

Expanding Indications for IV Thrombolysis in Acute Ischemic Stroke Since the original NINDS trial in 1995, the eligibility criteria for intravenous alteplase have progressively widened. Early limitations—such as narrow time windows, strict age cutoffs, and exclusion of patients with unknown onset—have given way to a more nuanced, individualized approach to thrombolytic therapy. Time Windows:…

Contraindications Contraindication Timing / Context Guideline Statement Mild nondisabling stroke Any Time IV alteplase is not recommended for NIHSS 0–5 with nondisabling symptoms Extensive hypoattenuation on CT Any time Not recommended; indicates irreversible injury Acute intracranial hemorrhage On CT Contraindicated Ischemic stroke within prior 3 months History Potentially harmful Severe head trauma within 3…

Pushing the Clock: The Expanding Time Window for Ischemic Stroke In the mid-1990s, stroke treatment entered a new era with the approval of intravenous tPA within 3 hours of onset. Over the next three decades, progressive advances in imaging, patient selection, and trial design stretched the therapeutic window far beyond what once seemed possible.…

The History of tPA in Acute Stroke: A Turning Point in Vascular Neurology For decades, acute ischemic stroke was a therapeutic dead end—an emergency with no effective pharmacologic intervention. That changed in the mid-1990s with the introduction of intravenous tissue plasminogen activator (tPA), a breakthrough that fundamentally reshaped stroke care worldwide. Discovery of tPA:…