Thrombolysis vs Thrombectomy: A Stroke Family Guide | Healos™
Clot-Busting Drugs vs Clot Retrieval: What Stroke Families Should Know
When someone you love has a stroke, the emergency department moves fast and the words fly: "tPA", "TNK", "thrombectomy", "large vessel", "last known well". Families are often asked for information, and sometimes for consent, in the middle of the worst hour of their lives.
Understanding the two main treatments ahead of time makes that hour a little clearer.
Here is the short answer. For ischaemic stroke, there are two emergency treatments: clot-busting medicine (thrombolysis), usually within 4.5 hours of when the person was last known well, and clot retrieval (thrombectomy) for a large blocked artery, often within 6 hours and in selected people up to 24 hours. Many people receive both. Both work best the faster they're given, which is why families should call 911 and note the time symptoms started.
简短的答案： 当你爱的人发生卒中，急诊节奏飞快，各种词汇扑面而来：「溶栓」「TNK」「取栓」「大血管」「最后正常时间」。家属常常需要在人生最糟糕的一小时里提供信息，有时还要签字同意。
提前了解这两种主要治疗，能让那一小时清楚一点。
缺血性卒中有两种急救治疗：溶栓药物，通常在最后正常时间后 4.5 小时内使用；针对大血管堵塞的取栓，通常在 6 小时内，部分人可到 24 小时；很多人两者都会接受。两者都是越快越有效，所以家属应拨打 911，并记下症状开始的时间。
Thrombolysis: clot-busting medicine
Thrombolysis means giving a medicine through a vein to dissolve the clot. The long-standing drug is alteplase; many Canadian centres now use tenecteplase, given as a single injection, after the Canadian AcT trial showed it was as effective as alteplase (Menon et al., Lancet, 2022).
The evidence. In the landmark NINDS trial, people treated within 3 hours were at least 30% more likely to have minimal or no disability at 3 months (NINDS rt-PA Stroke Study Group, NEJM, 1995). Later trials extended the window to 4.5 hours for many patients.
The trade-off. Clot-busting medicine raises the risk of bleeding in the brain: symptomatic bleeding occurred in 6.4% of treated patients versus 0.6% on placebo in NINDS. That's why the team checks a CT scan first, and asks about blood thinners, recent surgery and bleeding problems.
Who can't have it. People whose stroke is a bleed, who arrive too late, or who have certain bleeding risks or take some anticoagulants.
溶栓：溶解血栓的药物： 溶栓是经静脉给药溶解血栓。经典药物是阿替普酶；加拿大 AcT 试验证明替奈普酶效果与阿替普酶相当之后（Lancet 2022），很多加拿大中心改用替奈普酶，只需一次注射。
证据：里程碑式的 NINDS 试验中，3 小时内治疗的人 3 个月时轻微或无残疾的可能性至少高 30%（NEJM 1995），之后的试验把很多患者的时间窗延长到 4.5 小时。
代价：溶栓会增加脑出血风险，NINDS 中有症状出血为 6.4%，安慰剂组为 0.6%；所以团队会先做 CT，并询问抗凝药、近期手术和出血问题。
谁不能用：出血性卒中、到达太晚、有某些出血风险或服用某些抗凝药的人。
Thrombectomy: clot retrieval
Thrombectomy is a procedure in which a specialist threads a catheter from the groin or wrist up to the brain and pulls the clot out. It's used when a large artery is blocked, which accounts for many of the most disabling strokes.
The evidence. In the HERMES analysis of 1,287 patients from five trials, thrombectomy raised the share of people living independently at 90 days to 46%, from 26.5% with standard care (Goyal et al., Lancet, 2016). In the DAWN trial, carefully selected patients treated 6 to 24 hours after onset reached functional independence 49% of the time, versus 13% (Nogueira et al., NEJM, 2018).
The practical reality. Thrombectomy is done only at specialised stroke centres, so paramedics and hospitals may transfer patients, sometimes after giving clot-busting medicine first. Not everyone qualifies; the decision depends on brain imaging, the site of the blockage and how much brain can still be saved.
取栓：把血栓取出来： 取栓是由专科医生把导管从腹股沟或手腕送到大脑，把血栓拉出来的手术，用于大动脉堵塞——很多最致残的卒中属于这一类。
证据：HERMES 汇总五项试验 1,287 名患者，取栓使 90 天生活自理的比例从标准治疗的 26.5% 提高到 46%（Lancet 2016）；DAWN 试验中，经严格筛选、发病 6–24 小时治疗的患者，功能独立比例为 49%，对照组为 13%（NEJM 2018）。
实际情况：取栓只能在专门的卒中中心进行，所以急救人员和医院可能会转运患者，有时先给溶栓药；并非人人符合条件，取决于脑部影像、堵塞部位以及还有多少脑组织可以挽救。
Why some people don't receive either
Families sometimes ask, later, why their loved one wasn't treated. Common reasons include: the stroke was caused by bleeding, where both treatments would be harmful; too much time had passed, or the time symptoms started was unknown; the blockage was in a small artery not reachable by thrombectomy; or bleeding risks outweighed the benefit. These are judgment calls made by the stroke team with the information available, and they're not a sign that care was withheld.
What every stroke patient does receive is the next layer of care: medicines to prevent another stroke, blood pressure control and rehabilitation (see what happens to your brain after a stroke).
为什么有些人两种治疗都没有接受： 家属有时事后会问，为什么家人没有接受这些治疗。常见原因包括：卒中由出血引起，两种治疗都会有害；时间过去太久，或不知道症状何时开始；堵塞在取栓够不到的小动脉；或出血风险超过获益。这些都是卒中团队根据当时信息做出的判断，并不意味着治疗被拒绝。
每位卒中患者都会接受的，是下一层照护：预防再次卒中的药物、血压控制和康复。
What families can do in the first hour
Call 911 immediately. Paramedics alert the hospital and can take the person straight to the right stroke centre. Don't drive yourself.
Note the time the person was last known well, not when you found them. This single detail often decides eligibility.
Bring a medication list, especially blood thinners, and mention recent surgery, bleeding or falls.
Stay reachable so the team can ask questions quickly.
Know BE FAST: Balance, Eyes, Face, Arm, Speech, Time to call 911 (see TIA: the first 48 hours).
家属在第一小时能做什么： 立即拨打 911：急救人员会提前通知医院，并直接送往合适的卒中中心，不要自己开车。记下「最后正常时间」，而不是你发现他的时间，这一个细节常常决定能否治疗。带上用药清单，尤其抗凝药，并说明近期手术、出血或跌倒。保持电话畅通，方便团队快速询问。记住 BE FAST：平衡、眼睛、面部、手臂、言语——立即拨打 911。
How Healos™ supports recovery after a stroke
Emergency treatment is entirely the stroke team's domain, and nothing replaces it. Afterwards comes the long work of recovery. The 91-Day Protocol moves through Detox, Replenish and Repair, with stroke-specific complementary nutrition matched to your medication list, follow-ups at day 30 and day 60 (with a reminder to book your blood test) and a blood-test report review at day 90. Sovereign Monthly · Recovery continues month to month. Neither affects emergency treatment decisions.
Healos™ 如何支持卒中后的康复： 急救治疗完全属于卒中团队的范畴，任何东西都无法替代。之后是漫长的康复工作：91 天方案依次经过排毒、补给、修复，提供与用药清单匹配的卒中专属辅助营养，第 30 天跟进、第 60 天跟进并提醒验血、第 90 天验血报告解读；Sovereign Monthly · Recovery 按月延续。两者都不影响急救治疗决策。
The bottom line
Clot-busting medicine dissolves the clot from inside the bloodstream, usually within 4.5 hours; clot retrieval physically removes a large clot, often within 6 hours and sometimes up to 24. Both transform outcomes when given fast, many people get both, and the stroke team decides. The most powerful thing a family can do is call 911 at once and know when the person was last well.
结论： 溶栓药物从血液内部溶解血栓，通常在 4.5 小时内；取栓则把大血栓直接取出，通常在 6 小时内，有时可到 24 小时。两者及时使用都能显著改变结局，很多人两者都会接受，由卒中团队决定。家属能做的最有力的事，是立即拨打 911，并知道患者最后正常的时间。
Frequently asked questions
What is the difference between thrombolysis and thrombectomy? Thrombolysis is a clot-dissolving medicine given through a vein, usually within 4.5 hours. Thrombectomy is a catheter procedure that physically removes a clot from a large brain artery, often within 6 hours and up to 24 hours in selected people.
How long after a stroke can clot-busting medicine be given? Usually within 4.5 hours of when the person was last known well, and the sooner the better. The team also checks a CT scan and bleeding risks first.
Who can have a thrombectomy? People whose stroke is caused by a blockage in a large brain artery, who reach a specialised centre in time and whose brain imaging shows tissue that can still be saved.
Why wasn't my family member given clot-busting medicine? Common reasons include a bleeding stroke, arriving outside the time window or an unknown onset time, a small-artery blockage, or bleeding risks such as certain blood thinners.
常见问题：
溶栓和取栓有什么区别？溶栓是经静脉给药溶解血栓，通常 4.5 小时内；取栓是经导管把大血管里的血栓取出，通常 6 小时内，部分人可到 24 小时。
多久内可以溶栓？通常在最后正常时间后 4.5 小时内，越早越好，并需先做 CT 和评估出血风险。
谁可以取栓？大血管堵塞、及时到达专门中心、影像显示仍有可挽救脑组织的人。
为什么家人没有溶栓？常见原因有出血性卒中、超出时间窗或发病时间不明、小血管堵塞、某些抗凝药等出血风险。
References
The National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group. Tissue plasminogen activator for acute ischemic stroke. New England Journal of Medicine. 1995;333:1581–1587.
Menon BK, et al. Intravenous tenecteplase compared with alteplase for acute ischaemic stroke in Canada (AcT). Lancet. 2022;400(10347):161–169.
Goyal M, et al. Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomised trials (HERMES). Lancet. 2016;387(10029):1723–1731.
Nogueira RG, et al. Thrombectomy 6 to 24 hours after stroke with a mismatch between deficit and infarct (DAWN). New England Journal of Medicine. 2018;378:11–21.
