Clinical Scenario
Hyperacute stroke — thrombolysis & thrombectomy
IMMEDIATE
- ABCDE, NIHSS, glucose, ECG, urgent CT/CTA.
- Time of onset critical.
THROMBOLYSIS
Alteplase 0.9 mg/kg (max 90 mg) — 10% bolus, rest over 1 h — within 4.5 h of onset if no contraindication (recent bleed, surgery, anticoagulation INR >1.7, severe HTN >185/110 despite treatment, recent stroke/TBI).
THROMBECTOMY
- Large vessel occlusion (ICA, M1, basilar) within 6 h (up to 24 h with favourable imaging).
- Refer to comprehensive stroke centre immediately.
POST
- Stroke unit admission, swallow screen, antiplatelet (aspirin 300 mg 14 days then clopidogrel 75 mg), statin, BP cautious lowering, glucose 6–10.
- Investigate cause: carotid Doppler, echo, 24 h tape for AF.
SECONDARY PREVENTION
DOAC for AF, carotid endarterectomy within 14 days for symptomatic stenosis >50%, lifestyle, BP target <130/80.