ESO guidelines provide recommendations on intravenous thrombolysis for acute ischemic stroke

Patients with stroke due to blood clots in brain arteries ('ischaemic stroke') can be treated with clot-dissolving drugs called 'thrombolytics'. By dissolving blood clots, thrombolytic drugs improve brain blood supply and lead to better recovery. However, thrombolytic drugs may cause bleeding in the brain which can lead to worse disability or death. The most commonly used thrombolytic drug for ischemic stroke is called alteplase.

The European Stroke Organisation (ESO) guidelines on intravenous thrombolysis for acute ischaemic stroke provides forty recommendations on the use of thrombolytic drugs. The module working group, led by Guillaume Turc, William Whiteley and the late Eivind Berge, has written evidence-based recommendations and expert consensus statements covering the topics of early and late time windows, stroke of unknown onset, advanced imaging, alteplase and tenecteplase, minor and severe strokes, patients over 80 or with previous disability or frailty, and potential risk factors for bleeding including use of oral anticoagulants.

Overall, the major recommendations were supported by high to moderate quality evidence. Other than for age and stroke severity, weaker evidence was available to support when to use alteplase.

In due course, the ESO guidelines on management of Transient Ischemic Attack, prepared by a module working group chaired by Aine Merwick and Ana Catarina Fonseca, will cover important topics such as services organization including the role of stroke specialists and TIA clinics; usefulness of risk prediction tools such as the ABCD2 score; brain imaging (plain and perfusion CT, MRI), imaging of cervical arteries, and single and dual antiplatelet therapy.

Journal reference:

Berge, E., et al. (2021) European Stroke Organisation (ESO) guidelines on intravenous thrombolysis for acute ischaemic stroke. European Stroke Journal.


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