IVT and stroke severity

Q: The high severity of neurologic deficit in stroke should be considered for intravenous thrombolysis (IVT) due to the high risk of intracerebral hemorrhage.

A) True

B) False

Answer: B

The severity of neurologic deficit is measured by the National Institutes of Health Stroke Scale (NIHSS) score. Although the high severity of neurologic deficit is indeed associated with high risk of intracerebral bleed, stroke severity alone should not be used to determine a patient's inclusion or exclusion for IVT therapy. The benefit of IVT is similar regardless of stroke severity.

#neurology

References:

1. Emberson J, Lees KR, Lyden P, et al. Effect of treatment delay, age, and stroke severity on the effects of intravenous thrombolysis with alteplase for acute ischaemic stroke: a meta-analysis of individual patient data from randomised trials. Lancet 2014; 384:1929.

2. Whiteley WN, Emberson J, Lees KR, et al. Risk of intracerebral haemorrhage with alteplase after acute ischaemic stroke: a secondary analysis of an individual patient data meta-analysis. Lancet Neurol 2016; 15:925.

3. Whiteley WN, Slot KB, Fernandes P, et al. Risk factors for intracranial hemorrhage in acute ischemic stroke patients treated with recombinant tissue plasminogen activator: a systematic review and meta-analysis of 55 studies. Stroke 2012; 43:2904.