Stroke Thrombolysis

The research on from which the current protocols were developed are available for downloading on the right hand side of this page. In addition the Safe Implementation of Thrombolysis in Stroke (SITS) have a protocol which is also available for your information.

Straying outside of the protocols tends to lead to an increase in the cerebral haemmorhage rate and therefore an increase in the mortality. IST3 is currently running and will show whether extending the window of oppurtunity from 3 to 6 hours post event is beneficial.

As a quick visible guide below are the current inclusion and exclusion criteria as per the SITS protocol. Local implementation may vary so please consult your own department.

Inclusion Criteria

Female or male inpatients
Age 18 – 80 years
Clinical diagnosis of ischaemic stroke causing a measurable neurological deficit defined as impairment of language, motor function, cognition, gaze, vision and/or neglect.
Ischaemic stroke is defined as an event characterised by sudden onset of acute focal neurological deficit, presumed to be caused by cerebral ischaemia, after CT scan exclusion of haemorrhage
Onset of symptoms within 3 hours prior to initiation of thrombolysis treatment
Stroke symptoms present for at least 30 minutes and has not significantly improved before treatment. Symptoms must be distinguishable from an episode of generalized ischaemia (i.e. syncope), seizure, or migraine disorder
Patients are willing to receive thrombolysis treatment and to give informed consent with regard to retrieval of data and follow up procedures, according to the regulations in participating countries
Willingness and ability to comply with the study protocol

Exclusion Criteria

The cerebral CT exclusion criteria are:

Evidence of intracranial haemorrhage (ICH) on the CT-scan

The general exclusion criteria are:

Symptoms of ischaemic attack began more than 3 hours prior to infusion start or when time of symptom onset is unknown
Minor neurological deficit or symptoms rapidly improving before start of infusion.
Severe stroke as assessed clinically (e.g. NIHSS>25) and/or by appropriate imaging techniques
Seizure at onset of stroke
Symptoms suggestive of subarachnoid haemorrhage, even if the CT-scan is normal
Administration of heparin within the previous 48 hours and a thromboplastin time exceeding the upper limit of normal for laboratory
Patients with any history of prior stroke and concomitant diabetes
Prior stroke within the last 3 months
Platelet count of below 100,000/mm3
Systolic blood pressure >185 mmHg or diastolic blood pressure >110 mmHg, or aggressive management (IV medication) necessary to reduce BP to these limits.
Blood glucose <50 or > 400 mg/dl.
Known haemorrhagic diathesis
Patients receiving oral anticoagulants, e.g. warfarin sodium
Manifest or recent severe or dangerous bleeding
Known history of or suspected intracranial haemorrhage
Suspected subarachnoid haemorrhage or condition after subarachnoid haemorrhage from aneurysm
Any history of central nervous system damage (i.e. neoplasm, aneurysm, intracranial or spinal surgery)
Haemorrhagic retinopathy,e.g. in diabetes (vision disturbances may indicate haemorrhagic retinopathy)
Recent (less than 10 days) traumatic external heart massage, obstetrical delivery, recent puncture of a non-compressible blood-vessel (e.g. subclavian or jugular vein puncture
Bacterial endocarditis, pericarditis
Acute pancreatitis
Documented ulcerative gastrointestinal disease during the last 3 months, oesophageal varices, arterial- aneurysm, arterial/venous malformation
Neoplasm with increased bleeding risk
Severe liver disease, including hepatic failure, cirrhosis, portal hypertension oesophageal varices) and active hepatitis
Major surgery or significant trauma in past 3 months

stroke thrombolysis