A patient experiences a stroke upon discharge; what is the next step in management?

• A. Begin rehabilitation
• B. Order a CT scan
• C. Administer IV TPA
• D. Start anticoagulation therapy

Answer: (C)

In the context of a patient experiencing a stroke upon discharge, the immediate next step in management hinges on the type of stroke that has occurred. If the stroke is ischemic, which is often treated with tissue plasminogen activator (TPA), then administering IV TPA would be the correct approach, provided that it falls within the appropriate time window and the patient meets all other eligibility criteria for TPA administration, such as the absence of contraindications.

IV TPA is a thrombolytic agent that acts to dissolve the clots that cause ischemic strokes, restoring blood flow to the affected brain tissue. It is a critical intervention that has been shown to improve outcomes in eligible patients if administered promptly after the onset of stroke symptoms. This factor makes the choice of administering IV TPA particularly relevant in the case of an acute ischemic stroke.

Other management steps, such as starting anticoagulation therapy, may be important in the overall management of stroke but are generally not the immediate first step in the acute phase, especially if the stroke has just occurred. Similarly, rehabilitation is a vital component of stroke recovery but comes after the initial acute management of the stroke itself. A CT scan, while important for assessing the type of stroke (ischemic vs.