Q. What else should happen whilst Jimmy and his wife are awaiting the CT scan? Select the crosses for more details.
For a comprehensive list of contraindications and cautions on Alteplase see:
For more detailed information regarding patient and family information see:
- Patient UK – Thrombolytic Treatment of Acute Ischaemic Stroke
- Thrombolysis: patient decision leaflet (June 2017) NHS Lothian [.pdf 222 KB]
- The Leeds Teaching Hospitals NHS Trust ‘Alteplase, a treatment for stroke’ [.doc, 629 KB]
- Patient experience of thrombolysis following stroke
What else should happen whilst Jimmy and his wife are awaiting the CT scan?
Check for contraindications for receiving thrombolysis
The only absolute contraindications to thrombolysis are:
- Active or very recent severe bleeding e.g. intracerebral, SAH, Subdural, gastrointestinal
- Full anticoagulation (if with Warfarin INR>1.6)
However, other factors may influence the balance of risk and benefit, so thrombolysis will not be given.
None of these should delay the CT scan but:
Weigh the patient:
To allow the dose of thrombolysis to be calculated, or read off a dosing sheet. If the patients cannot sit or stand on scales a weighing PAT slide, or bed/trolley or hoist can be used.
Check for factors which influences risks and benefits:
-
- Interval since last well – shorter intervals greater benefit
- Severity and potential impact of stroke deficits – greater severity greater benefit
- Pre stroke functional state – worse status – less benefit
- History of recent trauma or bleeding – less benefit
- Anticoagulant use – greater risk – less benefit
- History of other coagulopathy – greater risk – less benefit
- Recent history of stroke – greater risk – less benefit
- Pregnancy or recent child birth – greater risk – less benefit
- Epileptic seizure since onset – uncertain diagnosis -reduced benefit
- Current blood pressure – higher BP, potentially greater risk – less benefit (see additional information)
- Current BM stick – very low or high – uncertain diagnosis -reduced benefit
Send off the bloods, urgent clotting if on Warfarin:
For full blood count (FBC), clotting screen, blood sugar, urea, creatinine & electrolytes (U&Es), cholesterol and liver function tests (LFTs). You do not need to wait for blood results before giving thrombolysis treatment unless you suspect a significant abnormality. However, severe anaemia (Hb<100g/l, clotting abnormalities (INR>1.6), very low platelets, hyperglycaemia (blood sugar > 22 mmol/l) or very abnormal biochemistry may be reasons not to give thrombolysis treatment.
ECG:
An ECG may detect atrial fibrillation, or a evidence of a recent myocardial infarction which may have led to the stroke.
To identify AF, or recent MI:
Arrange where the patient will go after any hyper acute treatment
Patient will need to be monitored closely after thrombolysis to detect complications as early as possible.
This is usually best done on a stroke unit with sufficient well trained nursing staff, but is sometimes performed in other high dependency settings where training has been provided.
Speak to Jimmy and his wife
Check the time of symptom onset
Provide a verbal explanation about:
- What’s happening
- CT scan and what the investigation entails
- The importance of confirming a diagnosis
- Thrombolysis and/or thrombectomy treatments if suitable for Jimmy and the benefits and risks
Provide support and reassurance to Jimmy and his wife.
Check if any other family members could be contacted.
