American Board of Internal Medicine (ABIM) Certification Practice Exam

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What is the acceptable timeframe for thrombolysis in cases of ischemic stroke?

Within 6 hours
Within 2 hours
Within 4.5 hours
Within 3 hours

The correct answer is: Within 3 hours

The recommended timeframe for thrombolysis in cases of ischemic stroke is within 4.5 hours of symptom onset. This window allows for the administration of thrombolytic therapy, which can significantly reduce disability and improve outcomes for patients experiencing an acute ischemic stroke. Clinical guidelines, such as those from the American Heart Association/American Stroke Association, endorse this 4.5-hour timeframe based on research showing that the benefits of treatment outweigh the risks, particularly the risk of hemorrhagic complications, within that period. Although therapies may still be considered up to 6 hours or longer in some specialized or controlled settings with advanced imaging techniques, the standard practice remains within 4.5 hours for most patients. It's essential to initiate treatment as soon as possible after stroke onset, as the effectiveness of thrombolysis decreases as time passes, leading to diminished potential recovery.