Indications and Acute Management of Non-Hemorrhagic Stroke, Including Thrombolytic Therapy

Introduction

Non-hemorrhagic stroke, also known as ischemic stroke, occurs due to an obstruction in the cerebral vasculature, leading to inadequate blood flow to the brain. Rapid intervention is essential to minimize neurological damage and improve outcomes.

Indications for Thrombolytic Therapy

Thrombolytic therapy, primarily using intravenous tissue plasminogen activator (IV tPA), is indicated in eligible patients within a narrow therapeutic window.

• Confirmed ischemic stroke via neuroimaging (CT/MRI)
• Symptom onset within 4.5 hours
• No contraindications such as active bleeding or high-risk conditions
• Absence of recent major surgery or trauma

Eligibility Criteria

Key eligibility criteria for thrombolysis include:

• Age ≥ 18 years
• Neurological deficits assessed using NIH Stroke Scale
• Normal coagulation profile and platelet count
• No history of intracranial hemorrhage

Contraindications

Absolute contraindications include:

• Active intracranial or systemic bleeding
• Recent major surgery (past 14 days)
• Severe uncontrolled hypertension
• Current anticoagulation with high INR

Acute Management Protocol

The management of ischemic stroke involves rapid assessment and treatment:

• Initial Evaluation: History, stroke severity scoring (NIHSS), and imaging.
• Thrombolysis Administration: IV tPA at 0.9 mg/kg dosage.
• Post-Treatment Monitoring: Neurological assessments and blood pressure management.

Conclusion

Thrombolytic therapy is a critical intervention for non-hemorrhagic stroke patients, provided they meet eligibility criteria. Rapid diagnosis and adherence to treatment protocols can significantly improve patient outcomes.