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Intravenous tPA Thrombolysis: Use in Acute Ischemic Stroke

Tissue plasminogen activator (tPA) administration in acute ischemic stroke can dissolve the clot and reverse damage.

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

References (5)

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Acil Servis department. Book Appointment →

What is Intravenous tPA Thrombolysis: Use in Acute Ischemic Stroke?

Intravenous tPA (alteplase, tenecteplase) is a fibrinolytic agent that dissolves the clot in the cerebral artery during acute ischemic stroke. It is standard therapy in eligible patients within the first 4.5-hour 'window'.

A rapid checklist is applied to exclude contraindications such as bleeding, recent surgery and severe hypertension. Hemorrhage must be ruled out by CT.

The thrombolysis decision follows the 'time is brain' principle: millions of neurons are lost every minute; early treatment significantly improves long-term quality of life.

Symptoms

Sudden onset unilateral weakness or sensory loss
Speech disturbance or comprehension impairment
Facial asymmetry, mouth deviation
Sudden visual loss or double vision
Sudden loss of balance, dizziness
Sudden severe headache
Altered consciousness
Neurologic deficit measured by NIHSS

Risk Factors

Head trauma or stroke in last 3 months
Active internal bleeding or bleeding diathesis
Gastrointestinal bleeding in last 21 days
Platelet count <100,000
INR >1.7 or heparin use
Uncontrolled hypertension (>185/110)
Recent major surgery
Blood glucose <50 mg/dL

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • If FAST symptoms are present, call 112 and go to a stroke center
  • Last known well time must be documented
  • Whether the patient takes aspirin or oral anticoagulant must be recorded
  • If the symptom onset is unclear, perform tissue clock assessment with MRI

Treatment Methods

01
Door-to-needle time targeted under 60 minutes
02
Screening with the contraindication checklist
03
Hemorrhage excluded with non-contrast brain CT
04
Blood pressure targeted <185/110
05
tPA at 0.9 mg/kg, maximum 90 mg
06
10% bolus followed by 60-minute infusion
07
Intensive monitoring for the first 24 hours
08
Referral for thrombectomy in large vessel occlusion
09
Frequent neurologic examination for bleeding risk
10
Antithrombotic started after 24-hour control imaging

Which Department to Visit?

You can visit our Acil Servis department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

Learn About Acil Servis Department

Let us help you

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.