Immediate Goals for Ischemic Stroke Post-Thrombolysis

Critical Monitoring Requirements

The American Heart Association recommends maintaining strict blood pressure control with systolic BP <180 mmHg and diastolic BP <105 mmHg during and after tPA infusion 1
The American College of Cardiology suggests that excessive and prolonged hypotension should be avoided, as it can compromise cerebral perfusion 1
Emergency antihypertensive treatment is warranted if BP exceeds these thresholds to reduce hemorrhagic transformation risk, as recommended by the American Heart Association 2

The American Stroke Association recommends obtaining a CT scan 24 hours after tPA administration to exclude intracranial hemorrhage before initiating any antithrombotic therapy 1
Symptomatic intracranial hemorrhage occurs in approximately 6.4% of tPA-treated patients, according to the American Heart Association 4
Any neurological deterioration should prompt immediate repeat imaging, as suggested by the American College of Cardiology 2

The American College of Chest Physicians recommends avoiding all antithrombotic drugs (including aspirin) until after the 24-hour post-thrombolysis scan has excluded intracranial hemorrhage 1, 5
Once hemorrhage is excluded, aspirin (160-325 mg) should be initiated immediately, as recommended by the American Heart Association 1, 5

The American Stroke Association suggests that patients should be transferred to a dedicated stroke unit as soon as possible, ideally within 24 hours of hospital arrival, to reduce death and dependency 2
Stroke unit care reduces death, death or institutionalization, and death or dependency compared to non-specialized units, according to the American College of Cardiology 3

The American Heart Association recommends that initial assessment by rehabilitation professionals should be performed within 48 hours of admission, and rehabilitation therapy should begin as soon as possible once the patient is medically stable 6
The "out of bed within 24-hour principle" should be followed when feasible, as suggested by the American College of Cardiology 7

Delaying transfer to stroke unit beyond 2 days is associated with increased complications, according to the American Stroke Association 3
Failing to maintain strict BP control increases hemorrhagic transformation risk, as recommended by the American Heart Association 1
Starting antiplatelet or anticoagulant therapy before the 24-hour exclusionary CT scan significantly increases bleeding risk, according to the American College of Chest Physicians 1, 5