Use of Thrombolytics for the Management of Acute Ischemic Stroke in the Emergency Department

Official 2024 guideline from the American College of Emergency Physicians.

Strength

Recommendations

Treatment

Level B

In stroke patients who are candidates for both mechanical thrombectomy and intravenous thrombolytics (IVT), IVT should be offered and may be given prior to mechanical thrombectomy. IVT is given within 4.5 hours from symptom onset.

Level C

When feasible, shared decision making between the patient (and/or their surrogate) and a member of the health care team should include a discussion of potential benefits and harms prior to the decision whether to administer intravenous thrombolytics (consensus recommendation).

Literature

Original/Primary Reference

Lo BM, Carpenter CR, et al. Clinical Policy: Use of Thrombolytics for the Management of Acute Ischemic Stroke in the Emergency Department. Ann Emerg Med. 2024;84(6):e57-e86.

What do the ratings mean?

Level A

Generally accepted principles for patient management that reflect a high degree of clinical certainty (ie, based on strength of evidence Class I or overwhelming evidence from strength of evidence Class II studies that directly address all of the issues).

Level B

Recommendations for patient management that may identify a particular strategy or range of management strategies that reflect moderate clinical certainty (ie, based on strength of evidence Class II studies that directly address the issue, decision analysis that directly addresses the issue, or strong consensus of strength of evidence Class III studies).

Level C

Other strategies for patient management that are based on preliminary, inconclusive, or conflicting evidence, or in the absence of any published literature, based on panel consensus.