What action should be taken if a patient's NIHSS changes negatively after receiving thrombolytic therapy?

The appropriate action when a patient's NIHSS (National Institutes of Health Stroke Scale) score changes negatively after receiving thrombolytic therapy is to perform additional imaging to assess for complications. A worsening NIHSS score may indicate potential complications such as intracerebral hemorrhage or other forms of stroke evolution, which require immediate evaluation.

Acute stroke management heavily relies on identifying and mitigating risks associated with thrombolytic therapy, including bleeding complications. Performing imaging, like a CT scan or MRI, can help detect these complications early, allowing for prompt intervention if needed. This is crucial because the window for effective intervention in acute strokes is time-sensitive, and recognizing alterations in the patient's condition can significantly influence the management plan.

While monitoring the patient and providing supportive care is essential, it does not address the potential urgent complications arising after thrombolytic treatment. Continuation of thrombolytic therapy without reassessing the patient's condition could lead to further deterioration. Switching to a different anticoagulant immediately is also not recommended, as it does not address the likely complications directly related to the thrombolytic agent used. Therefore, immediate imaging is the most critical step to ensure optimal patient safety and care following any negative changes in the patient's assessment.