Pressing issue in modern angioneurology is an improving diagnostic and therapeutic measures aimed at increa sing the effectiveness of thrombolytic therapy for cerebral infarction. Modern scientific data indicate that determining indications and contraindications for TLT is a multi-stage process based on the fundamental principle of «time is brain health.» This review presents current recommendations and scientific data reflecting approaches to optimizing the diagnosis and treatment of conditions associated with adverse outcomes after thrombolysis. Particular attention is paid to risk stratification for hemorrhagic transformation of the infarct zone based on the results  of several laboratory parameters (platelet count, INR, fibrinogen, D-dimer, absolute neutrophil to lymphocyte  ratio, glycemia, creatinine) before the start of thrombolytic therapy (TLT). Examples of laboratory data are given, the specific dynamics of which can, with a high degree of probability, predict an unfavorable outcome after completion of TLT in the first 24 hours. The need for regular scientific research aimed at improving the diagnosis and treatment of pathological processes associated with adverse outcomes after TLT is demonstrated. The term «pre-thrombolytic preparation» is substantiated and proposed for widespread use to clearly define a set of diagnostic and therapeutic measures aimed not only at determining the indications and contraindications for the use of etiopathogenetically substantiated hardware and/or drug methods for the treatment of MI, but also for the development of new methods for early diagnosis and treatment before prescribing thrombolytic therapy, simultaneously with thrombolytic therapy and within 24 hours after completion of thrombolytic therapy.

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