Thrombolytic Therapy for Stroke

An ischemic stroke occurs when blood flow to the brain is blocked. This is most often because of a blood clot in an artery in the brain or artery leading to the brain. Treatment is needed right away to help dissolve the clot and restore normal blood flow. Restoring normal blood flow can limit damage to brain tissue and improve outcome. With thrombolytic therapy, a clot-busting medicine called alteplase (recombinant tissue plasminogen activator or tPA) is used to dissolve the clot.

Side view of head and neck showing brain with damage. Inset shows blood clot lodged in brain artery.

Before the treatment

  • People with certain health problems have increased risks for problems with thrombolytic therapy.  For this reason, a detailed health history must be taken to check whether it is safe to have the treatment. Tell your healthcare provider about any health problems you have. The provider will also ask whether you’ve had specific problems, such as a past stroke, head injury, and bleeding in the brain.

  • Tell the healthcare provider about all medicines you take. Mention if you take blood thinners (anticoagulants). Also mention if you take over-the-counter medicines, herbal medicines, or other supplements.

  • Tell your healthcare provider if you use alcohol or tobacco products so that he or she can give you with the safest possible care.

  • Tell your healthcare provider if you are pregnant or if you have had recent surgery or head injury.

  • Certain tests need to be done before the treatment. These include blood tests and imaging tests, such as a CT or MRI scan of the brain.

  • Treatment with a thrombolytic must start within 4.5 hours after symptoms start.

  • To be eligible you must have symptoms that continue plus a diagnosis of ischemic stroke.

  • Your blood sugar will be checked to rule out low blood sugar as cause of symptoms.

  • Two IV lines will be placed in your hand or arm.

  • Your blood pressure may be lowered before giving a thrombolytic.

During the treatment

The treatment is done using an IV line. This is a small tube that is put in a vein in the hand or arm. Clot-busting medicine is sent through the IV line to reach the clot. The medicine is delivered non-stop for one or more hours. You’ll be watched closely throughout the treatment. You will be admitted to an intensive care unit or a stroke unit for at least 24 hours for monitoring. Blood pressure must remain below 180/105 mmHg for the first 24 hours after therapy.

After the treatment

After the treatment, you’ll need to stay in the hospital for at least several days. More imaging tests will be done to check how well the clot is dissolving. Other tests may also be done to help find the cause of the stroke.

Risks and possible complications

  • Bleeding in the brain or elsewhere in the body

  • Allergic reaction to the clot-busting medicine. This includes skin rash, itching, or swelling of your face or tongue.

  • Chest pain or pressure

  • Severe headache

  • Shortness of breath

  • Worsening of heart problems

  • Dizziness or lightheadedness

  • Nausea and vomiting

  • Death

Follow-up care

Recovery from a stroke can take several months or longer. Keep all follow-up appointments with your doctor. These are needed to monitor your health and how well you are recovering. You may need other treatments such as medicines, rehab (rehabilitation), and surgery in the future. Your healthcare provider will discuss these with you as needed.

Call 911

Call 911 or go to an ER (emergency room) right away if you have any of the following signs of a stroke:

  • Sudden, unexplained numbness or weakness on one side of the body

  • Problems seeing, double vision, or blurry vision

  • Sudden confusion or problems with speech

  • Sudden dizziness, trouble walking, or problems with balance

  • Sudden, severe headache

Think F.A.S.T.

F.A.S.T. is an easy way to remember the signs of a stroke. When you see these signs, you will know that you need to call 911 fast.

F.A.S.T. stands for:

  • F is for face drooping. One side of the face droops or is numb. When the person smiles, the smile is uneven. 

  • A is for arm weakness, One arm is weak or numb. When the person lifts both arms at the same time, one arm may drift downward. 

  • S is for speech difficulty. You may  notice slurred speech or difficulty speaking. The person can't repeat a simple sentence correctly when asked. 

  • T is for time to call 911. If someone shows any of these symptoms, even if they go away, call 911 right away. Make note of the time the symptoms first appeared. 

If you are at risk for having a stroke: 

  • Keep a list of important phone numbers next to your phone or in your cell phone list of contacts. Include your doctor and relatives or friends you want to be contacted. 

  • Carry a list of all medicines you take and the dosages of each, in your wallet. Include over-the-counter medicines, vitamins, and supplements. 

  • Write a brief health history, including any other medical problems you have had and the dates. Keep this with the medicine list.