In acute ischemic stroke, when should fibrinolytic therapy ideally be initiated?

Fibrinolytic therapy, such as tissue plasminogen activator (tPA), is most effective when administered as soon as possible following the onset of symptoms in acute ischemic stroke cases. The ideal window for initiating this treatment is typically within 3 to 4.5 hours of symptom onset. This rapid administration is critical because the sooner the therapy is administered, the better the chances of restoring blood flow to the brain and minimizing permanent damage to brain tissue.

The recommendation emphasizes that time is of the essence in managing acute ischemic stroke, which relates to why initiating treatment within 1 hour of the patient’s arrival is favorable. Quick intervention can lead to better functional recovery and outcomes for the patient. Thus, starting fibrinolytic therapy shortly after the patient's arrival is aligned with best practices for improving stroke outcomes, supporting the rationale behind preferring early intervention.

Other choices reflect misinterpretations of the guidelines; initiating therapy beyond the critical early window can result in diminished benefits or increased risk of complications, such as bleeding.