22
General Supportive Early Management
4.6.1. Thrombolysis Decision-Making
COR LOE
Recommendations
General Principles
1 A
1. In adult patients with AIS with disabling deficits, regardless
of NIHSS score), and eligible for IVT, faster treatment
improves functional outcomes.
1 B-NR
2. (New and of High Impact) In adult patients with AIS who
are eligible for IVT within 4.5 hours of symptom onset,
treatment should be initiated as quickly as possible, assuring
safe administration and avoiding potential delays associated
with additional multimodal neuroimaging, such as CTA/
MRA, and CT/MR perfusion imaging.
1 B-NR
3. In patients with AIS undergoing IVT, health care
professionals should be prepared to treat potential emergent
adverse effects, including bleeding complications and
angioedema, which may cause partial airway obstruction, to
reduce poor clinical outcomes.
1 C-EO
4. In patients with AIS eligible for IVT, health care professionals
should discuss its potential risks and benefits with competent
patients and/or available patient representatives, when
feasible, to ensure shared decision-making.
1 B-NR
5. In patients with suspected ischemic stroke, treating health
care professionals should determine blood glucose levels
before IVT initiation to assess and urgently treat severe
hypoglycemia and hyperglycemia, which may mimic acute
stroke presentations.
1 C-LD
6. In patients with suspected ischemic stroke with severe
hypoglycemia or hyperglycemia, if symptoms of disabling
stroke persist despite correction to normoglycemia,
administration of IVT is recommended to improve
functional outcomes.
1 A
7. In patients with AIS who are otherwise eligible for IVT with
early ischemic change of mild to moderate extent (other than
frank hypodensity attributable to the clinical presentation)
on initial brain imaging, IVT is recommended to improve
functional outcome.
4.6. IV Thrombolytics
