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Updated: Jun 14, 2026

A Thrombotic Stroke Model Based On Transient Cerebral Hypoxia-ischemia

A Thrombotic Stroke Model Based On Transient Cerebral Hypoxia-ischemia

Published on: August 18, 2015

Ethic issue in ischemic stroke patients wit thrombolytic therapy.

Cheung-Ter Ong¹, Yu-Hsiang Su, Sheng-Feng Sung

¹Department of Neurology, Chia-Yi Christian Hospital, Chia-Yi, Taiwan. ctong98@yahoo.com.tw

Acta Neurologica Taiwanica

|March 25, 2010

Summary

Ethical dilemmas arise when stroke patients outside guidelines receive thrombolytic therapy. Family insistence on recombinant tissue-type plasminogen activator (rt-Pa) treatment, despite risks like hemorrhagic transformation, complicates care decisions.

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Area of Science:

Neurology
Medical Ethics
Pharmacology

Background:

Thrombolytic therapy using recombinant tissue-type plasminogen activator (rt-Pa) improves stroke outcomes.
Ethical considerations surrounding rt-Pa infusion in stroke patients remain underexplored.

Observation:

Four stroke patients with middle cerebral artery infarcts presented within 3 hours of onset.
All patients' cases deviated from established thrombolytic therapy guidelines.
Families of three patients insisted on rt-Pa treatment, leading to two receiving it.

Findings:

Both patients receiving rt-Pa experienced hemorrhagic transformation; one died, the other had poor outcome (mRS 5).
Of the two not receiving rt-Pa, one suffered hemorrhagic transformation and died; the other had a poor outcome (mRS 5).

Implications:

Case studies reveal complexities in managing stroke patients who violate guidelines, especially when families push for thrombolytic therapy.
Open dialogue between clinicians, patients, and families is crucial, emphasizing risks like hemorrhagic transformation and mortality.
Informed consent, potentially via an 'against medical advice' form, is vital when families make treatment decisions for stroke patients outside standard protocols.