THRIVE Score for Ischaemic Stroke Outcome
Totaled Health Risks In Vascular Events (THRIVE) score. Predicts 90-day functional outcome, mortality and haemorrhage after thrombolysis in ischaemic stroke from NIHSS, age and chronic disease (hypertension, diabetes mellitus, atrial fibrillation). Score 0–9; higher score = worse outcome. Derived in the MERCI and Multi MERCI thrombectomy trials (Flint 2010) and validated in the NINDS tPA trial, VISTA and SITS-MOST.
Score interpretation
THRIVE 0-2 -- favourable prognosis; good functional outcome likely
→ Pursue all eligible acute treatments aggressively (thrombolysis, thrombectomy); stroke unit care; early rehabilitation; secondary prevention (adults): antiplatelet (aspirin 300 mg loading then 75 mg OD, switch to clopidogrel at day 14 for most patients), statin (atorvastatin 40-80 mg OD), antihypertensives; anticoagulation if AF confirmed (DOAC preferred unless contraindicated); lifestyle modification; early supported discharge. Children: use a children's formulary.
THRIVE 3-5 -- moderate prognosis; meaningful recovery possible with treatment
→ Active stroke treatment; early goals of care discussion with patient and family; frank but compassionate prognostication; intensive rehabilitation from day 1; swallow screen and SALT assessment; physiotherapy and occupational therapy from day 2; manage comorbidities (glucose control -- avoid hyperglycaemia, hypertension, AF rate/rhythm control); palliative care input if patient preference or poor trajectory; document THRIVE and MDT discussion in notes.
THRIVE 6-9 -- high mortality and disability risk; goals of care discussion essential
→ Immediate and compassionate goals of care discussion with family and patient (if capacity); acute treatments still warranted if eligible (thrombectomy for LVO, thrombolysis -- decision should not be based on THRIVE alone); DNACPR and ceiling of treatment discussion; palliative care early referral; maintain comfort: nutrition/hydration, oral hygiene, pressure care, pain management; decompressive hemicraniectomy discussion if malignant MCA infarct (age below 60 and within 48h); family support; chaplaincy/spiritual care if requested; document all discussions meticulously.
Interpretation bands for the THRIVE Score. Apply clinical judgement and local guidance.
References
- Flint AC, et al. Predicting long-term outcome after endovascular stroke treatment: the Totaled Health Risks in Vascular Events score. AJNR Am J Neuroradiol. 2010;31(7):1192–1196.
- Flint AC, et al. THRIVE score predicts ischemic stroke outcomes and thrombolytic hemorrhage risk in VISTA. Stroke. 2013;44(12):3365–3369.
- NICE NG128. Stroke and transient ischaemic attack in over 16s: diagnosis and initial management. NICE. 2019 (updated 2023).
Related
Curated clinical cross-links plus same-class fallbacks.
- Aspirin (Loading Dose) · Antiplatelet — ACS / Ischaemic Stroke
- Alteplase (tPA) · Thrombolytic — Ischaemic Stroke / Massive PE
- Tenecteplase (Stroke) · Stroke Thrombolysis
- Alteplase (STEMI Thrombolysis) · Thrombolytic / STEMI
- Streptokinase (STEMI Thrombolysis) · Thrombolytic / STEMI
- Edoxaban (AF Stroke Prevention / VTE) · Direct Factor Xa Inhibitor (DOAC)
- Acute Stroke / TIA Assessment · NICE NG128; RCP Stroke Guidelines 2023
- Status Epilepticus (Adults) · NICE CG137; ESEM guidelines; RCP Neurology Guidelines
- Suspected Subarachnoid Haemorrhage · NICE NG228; RCEM 2023; AHA/ASA 2023
- Adult Head Injury · NICE NG232 (2023)
- Bell's Palsy / Facial Nerve Palsy · ENT UK 2017; AAN
- Vertigo Workup · ENT UK; NICE CKS
Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.