Intracranial hemorrhage after thrombolytic therapy. A perspective.

The most feared complication of thrombolytic therapy is intracranial hemorrhage. Nevertheless, the benefits of thrombolysis far outweight the potential hazards of a cerebral bleed. In individual patients the expected benefit of thrombolytic therapy can be estimated by subtraction of the risk for intracranial hemorrhage from the predicted gain in survival. Accordingly, the net effect of thrombolysis will be beneficial in most patients who can be treated within the first 12 hours after symptom onset, even if one or two risk factors for intracranial hemorrhage can be identified. On the other hand, thrombolytic therapy is not warranted in elderly patients with a relatively small predicted infarct size and multiple risk factors for intracranial hemorrhage.