Intravenous tissue plasminogen activator (tPA) improves outcomes when administered within 4.5 hours of symptom onset of ischemic stroke.1 Symptomatic intracranial hemorrhage (sICH) is the most feared complication after administration of intravenous tPA. The percentage of patients with a good functional outcome after sICH (as defined by the Safe Implementation of Thrombolysis in Stroke-Monitoring Study2) following administration of tPA has been shown to be less than 7%, and mortality rates can be greater than 50%.3 Almost 2 decades after approval of intravenous tPA by the US Food and Drug Administration, our ability to prevent thrombolysis-related sICH has not advanced much beyond adhering to inclusion and exclusion criteria and controlling blood pressure after thrombolysis. Moreover, there is no clear consensus on how to manage thrombolysis-related sICH.4 Although the occurrence of sICH is uncommon, the known risk of this complication may weigh heavily on the decision to administer thrombolysis. The high morbidity and mortality associated with sICH represent an area where even a small improvement in prevention or treatment could have a dramatic effect.
Cossey T, Gonzales NR. Thrombolysis-Related Hemorrhage: Can We Make Thrombolysis Safer? JAMA Neurol. 2015;72(12):1416–1418. doi:10.1001/jamaneurol.2015.2900
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