The 2017 Chinese Stroke Association (CSA) scientific statement "Intravenous Thrombolysis in Acute Ischaemic Stroke" was published in Stroke and Vascular Neurology in 2017. The full English text can be accessed via the following link: https://svn.bmj.com/content/svnbmj/2/3/147.full.pdf.
Here is a brief introduction to the main content of the statement:
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For patients with acute ischaemic stroke (AIS) within 3 hours of symptom onset, intravenous thrombolysis should be offered if there are no contraindications (Class I, Level of Evidence A).
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For patients aged <80 years old, without a history of both diabetes and prior stroke, NIHSS <25, not taking any oral anticoagulants and without imaging evidence of ischaemic injury involving more than one-third of the MCA territory, intravenous alteplase within the 3-4.5 hour window is recommended (Class I, Level of Evidence B).
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The dosage of intravenous tissue plasminogen activator (tPA) is 0.9 mg/kg (maximum 90 mg), of which 10% is given as an intravenous bolus in 1 minute, the remaining given as intravenous continuous infusion over 1 hour (Class I, Level of Evidence A).
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A lower dose of tPA (0.6 mg/kg, maximum 60 mg, of which 15% is given as an intravenous bolus in 1 minute, the remaining given as intravenous continuous infusion over 1 hour) could be considered in AIS patients with high risk of developing haemorrhage (Class IIB, Level of Evidence C).
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Intravenous tPA is contraindicated in patients on warfarin with an INR >1.7 (Class III, Level of Evidence B).
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It is contraindicated in patients on low-molecular-weight heparin (LMWH) within the previous 24 hours (Class III, Level of Evidence B).
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For patients with major head trauma or a history of intracranial/spinal surgery within the prior 3 months, intravenous tPA is potentially contraindicated (Class III, Level of Evidence C).
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For AIS patients >80 years and with onset time of <3 hours, intravenous tPA is recommended (Class I, Level of Evidence A). The benefit of full-dose intravenous tPA for AIS patients >80 years and within 3-4.5 hour of onset is unclear (Class IIb, Level of Evidence B).
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For patients with severe stroke symptoms, intravenous tPA is recommended within 3 hours of symptom onset. Although the risk of haemorrhagic transformation may increase, there is still proven clinical benefit (Class I, Level of Evidence A).