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Use of thrombolysis in acute ischaemic stroke

Report by: Craig Ferguson, SPR Emergency Medicine

Institution: Salford Royal Foundation Trust, Salford, UK.

Original author: Dr Monojit Choudhury

Original institution: Stirling Royal Infirmary, Stirling, UK.

A shortcut review was carried out to establish whether thrombolysis improves mortality and functional outcome in patients diagnosed with an acute ischaemic stroke. One systematic review and three clinical trials were relevant to the question. The authors, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these papers are tabulated. The clinical bottom line is that although some patients will benefit, some will be harmed. It is still unclear how best to identify these two groups.

Three-part question

In [patients diagnosed with acute ischaemic stroke] does [thrombolysis] improve [mortality and functional outcome]?

Clinical scenario

A 49-year-old woman is brought to the ED by ambulance. She was having lunch with friends when she suddenly collapsed at the table. On arrival, she is aphasic and has a marked weakness of her right side. Her partner attends and informs you of her medical history, which consists of treated hypertension and nothing else of note. You arrange for an urgent CT scan and contact the on-call stroke physician. The patient has attended within 1 h of onset of symptoms and you wonder if she would be a candidate for thrombolysis. You mention this possibility to the patient's partner and he bombards you with a series of specific and highly appropriate questions regarding the risks and benefits of thrombolysis in patients with stroke. You point out that the diagnosis needs to be confirmed by CT scan before this treatment can even be considered and then cunningly deflect his questions towards the stroke physician who has just arrived in the department.

You are aware that thrombolysis for acute ischaemic stroke is considered beneficial for a …

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  • Provenance and peer review Not commissioned, internally reviewed by the Best BETs team.