Inclusion/exclusion criteria and decision making on thrombolysis treatment in stroke. Dr Anthony Pereira Department of Neurology St George’s Hospital

Inclusion 1: is the diagnosis stroke?

The disease

Inclusion 2: time is of the essence Lancet 2010; 375: 1695–703

Inclusion 3: is the scan normal?

Exclusions: are we going to harm them? Contraindications  Age under 18 or 80 years YesNo  Symptoms more than 4½ hours ago? YesNo  Time of symptom onset is unknown? YesNo  Deficit minor/rapidly resolving?YesNo  Active bleeding?YesNo  Trauma in the past 3 months?YesNo  CNS damage? YesNo  Anticoagulated? YesNo  Blood pressure limits >185/110 (either)? YesNo

So whom would you thrombolyse?  Patient whom you think has had a stroke  Within 4½ hours  Normal scan  No contraindications

How good is thrombolysis? Therefore, for every 20 patients treated,  1 extra will be cured (Rankin 0)  1 extra will do very well (Rankin 1)

Dose 0.9 mg/kg take a moment to stand back 10% STAT over 2 minutes 90% over 1 hour keep BP < 185/110 treat glucose aggressively avoid urinary catheter No aspirin etc for 24 hours What we do: treatment

THE END