Thrombolysis and Thrombectomy

Key points

• A combination of thrombolysis (alteplase OR tenecteplase — NG128 was amended in 2025 to include tenecteplase) AND thrombectomy is recommended for patients with an acute ischaemic stroke who present within 4.5 hours
• blood glucose, hydration, oxygen saturation and temperature should be maintained within normal limits
• blood pressure should not be lowered in the acute phase unless there are complications e.g. hypertensive encephalopathy
• aspirin 300mg orally or rectally should be given as soon as possible if a haemorrhagic stroke has been excluded
• with regards to atrial fibrillation, the RCP state: ‘anticoagulants should not be started until brain imaging has excluded haemorrhage, and usually not until 14 days have passed from the onset of an ischaemic stroke’