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Scope of Application
This guideline is intended for physicians working in emergency departments (EDs).
Inclusion Criteria
This guideline is intended for adult patients aged 18 years and older presenting to the ED with acute ischemic stroke.
Exclusion Criteria
This guideline is not intended to be used for pediatric or pregnant patients.
Recommendations offered in this policy are not intended to represent the only diagnostic and management options that the emergency physician should consider. ACEP recognizes the importance of the individual physician’s judgment and patient preferences.
In adult stroke patients who are a candidate for mechanical thrombectomy, is the use of intravenous thrombolytics (IVT) prior to mechanical thrombectomy (Bridge therapy) beneficial and safe versus mechanical thrombectomy alone?
None specified.
In stroke patients who are candidates for both mechanical thrombectomy and IVT*, IVT should be offered and may be given prior to mechanical thrombectomy.
* IVT is given within 4.5 hours from symptom onset
When feasible, shared decisionmaking between the patient (and/or their surrogate) and a member of the health care team should include a discussion of potential benefits and harms prior to the decision whether to administer intravenous thrombolytics (Consensus recommendation).
None specified.
In stroke patients who are candidates for both mechanical thrombectomy and IVT*, IVT should be offered and may be given prior to mechanical thrombectomy.
* IVT is given within 4.5 hours from symptom onset
When feasible, shared decisionmaking between the patient (and/or their surrogate) and a member of the health care team should include a discussion of potential benefits and harms prior to the decision whether to administer intravenous thrombolytics (Consensus recommendation).
