Thrombolysis in acute ischemic stroke

The administration of rt-PA to patients with acute ischemic stroke can result in improved functional outcomes. The safe and effective use of rt-PA in routine medical practice requires that patients seek help early, have a well-defined onset of their symptoms, be carefully examined for contraindications to rt-PA, receive a CT scan and interpretation to exclude hemorrhage, and receive the drug within a 3-hour period (Table 5). Intravenous rt-PA is given in a dosage of 0.9 mg/kg (up to a maximum of 90 mg) with 10 percent of the dose administered as a bolus followed by a 60-minute infusion within 3 hours of the onset of symptoms. If these conditions cannot be achieved, the drug should not be administered. Although most patients will not meet the criteria of the NINDS trial, rt-PA is an important advance in the treatment of acute ischemic stroke.