14
Treatment
Î In patients with mild stroke deficits, rapidly improving stroke
symptoms, major surgery in the preceding 3 months, and recent
myocardial infarction, consider use of IV fibrinolysis and weigh
potential increased risk against the anticipated benefits (IIb-C).
Note: These circumstances require further study.
Î The IV administration of streptokinase for treatment of stroke is NOT
recommended (III-A).
Î The use of IV rtPA in patients taking direct thrombin inhibitors or
direct factor Xa inhibitors may be harmful and is NOT recommended
unless sensitive laboratory tests such as activated partial
thromboplastin time (aPTT), international normalized ratio (INR),
platelet count, and ecarin clotting time (ECT), thrombin time (TT), or
appropriate direct factor Xa activity assays are normal, or the patient
has not received a dose of these agents for >2 days (assuming normal
renal metabolizing function). Similar consideration should be given to
patients being considered for intra-arterial rtPA (III-C).
