Table 4

Suggested guidelines for the use of intravenous r-TPA in ischaemic stroke [99]

• Intravenous r-TPA should be considered in all patients with a proved ischaemic stroke presenting within 3 hours of onset
• Recommended dose is 0.9 mg/kg, up to a maximum of 90 mg, the first 10% as a bolus, the rest as an infusion over 60 minutes
• Thrombolysis should be avoided in cases where the CT suggests early changes of major infarction (for example, sulcal effacement, mass effect, or oedema)
• Thrombolytic therapy should only be administered by physicians with expertise in stroke medicine, who have access to a suitable stroke service, with facilities for identifying and managing haemorrhagic complications
• Exclusion criteria: use of oral anticoagulants, or INR greater than 1.7; use of heparin in preceding 48 hours or prolonged partial thromboplastin time; platelet count less than 100 000mm3; stroke, or serious head injury in the previous 3 months; major surgery within previous 14 days; pretreatment systolic blood pressure greater than 185 mm Hg or diastolic greater than 110 mm Hg; rapidly improving neurological condition; mild isolated neurological deficits; previous intracranial haemorrhage; blood glucose greater than 22 mmol/l (400 mg/dl) or less than 2.8 mmol/l (50 mg/dl); seizure at stroke onset; gastrointestinal
or urinary bleeding within previous 21 days; or recent myocardial infarction
• Caution is advised before giving r-TPA to patients with severe stroke (NIH stroke scale score> 22)
• Recommended that treatment and adverse effects discussed with patient and family before treatment.