Thrombolysis for acute stroke: is it for everyone?

To date, there is only one US Food and Drug Administration-approved treatment for stroke. Many patients have benefited after receiving rt-PA within 3 hours of acute stroke. Although the risk of hemorrhagic conversion is real, the patients at high risk for this complication are often the same patients most at risk for poor outcome secondary to their ischemic events. In this article, we review the data supporting the use of thrombolytics, both intravenously and intra-arterially, as well as patient selection criteria. Furthermore, we provide a framework for administering rt-PA and discuss the future of thrombolytic therapy.