Q: 62 year old male had a witness embolic CVA in the hospital. Stroke team was promptly called and TPA was started while in radiology suite finishing CT scan protocol. What could be one hind side of giving thrombolytic therapy too early in CVA? 


Answer: Hyperacute thromboemboli is usually platelet-rich and this can make is resistant to thrombolysis. But this clinical pearl is only of academic importance and should not play any role in making the decision for thrombolytic therapy in CVA, as there is no way to known the exact composition of the thromboembolic material.


Reference: 

Fulgham JR, Ingall TJ, Stead LG, et al. Management of acute ischemic stroke. Mayo Clin Proc 2004; 79:1459.