Thrombolysis for acute ischaemic stroke: a new challenge for emergency medicine

INTRODUCTION: Acute ischaemic stroke (AIS) is a leading cause of death and disability within the United Kingdom. Despite evidence of the benefit of thrombolysis for appropriately selected patients with AIS, this intervention remains markedly underutilised in this country when compared with other developed countries. The delivery of thrombolysis for AIS has become a political, as well as a clinical, priority in the United Kingdom. DISCUSSION: Research has shown that, although thrombolysis for AIS is associated with increased short-term mortality, this is offset by a significant benefit in terms of reduced long-term death and disability. Recent observational data have shown that it can be safely and effectively delivered in the "normal" clinical setting (ie, a non-research environment). Furthermore, thrombolysis for AIS is supported by the Royal College of Physicians and the National Institute for Health and Clinical Excellence. Emergency physicians are trained to receive and assess patients with possible stroke. The emergency department (ED) is an ideal location in which to perform these clinical duties and to communicate and coordinate the necessary tasks required for the delivery of thrombolysis. All of the skills and resources are already available within the ED, with the exception of a single training requirement: certification in the National Institute for Health Stroke Scale scoring system, which can be acquired following limited Internet-based training. RESULTS: Emergency physicians should be integrally involved in the development of protocols for the delivery of thrombolysis to patients with AIS. This will require communication and collaboration locally with stroke physicians and radiologists, a process that should be facilitated by the newly emerging Stroke Networks.