CLINICAL POLICY : Use of Thrombolytics for the Management of Acute Ischemic Stroke in the Emergency Department

American College of Emergency Physicians Clinical Policies Subcommittee (Writing Committee) on Thrombolytics; \

Bruce M Lo, Christopher R Carpenter, Ken Milne, Peter Panagos, Jason S Haukoos, Deborah B Diercks; Members of the American College of Emergency Physicians (ACEP) Clinical Policies Committee (Oversight Committee); Deborah B Diercks, John D Anderson, Richard Byyny, Christopher R Carpenter, Benjamin W Friedman, Seth R Gemme, Charles J Gerardo, Steven A Godwin, Benjamin W Hatten, Jason S Haukoos, Amy Kaji, Heemun Kwok, Bruce M Lo, Sharon E Mace, Amal Mattu, Susan B Promes, Kaushal H Shah, Richard D Shih, Scott M Silvers, Andrea Slivinski, Michael D Smith, Molly E W Thiessen, John T Thompson, Christian A Tomaszewski, Stacy A Trent, Jonathan H Valente, Lauren M Westafer, Stephen P Wall, Yanling Yu, Michelle P Lin, John T Finnell, Travis Schulz, Kaeli Vandertulip

ABSTRACT                         

This clinical policy from the American College of Emergency Physicians (ACEP) is the revision of a clinical policy approved in 2015 addressing a critical question regarding the use of thrombolytics for the management of acute ischemic stroke. A writing committee conducted a systematic review of the literature to derive evidence-based recommendations to answer the following clinical question: In adult stroke patients who are a candidate for mechanical thrombectomy, is the use of intravenous thrombolysis prior to mechanical thrombectomy (Bridge therapy) beneficial and safe versus mechanical thrombectomy alone? Evidence was graded, and recommendations were made based on the strength of the available data.