Every thrombolysis decision is a wager against the clock and against the bleed. You are weighing the good a clot-buster can do against the small-but-real chance it turns an ischemic stroke into a hemorrhagic one. The SEDAN Score does not make that decision for you — nothing should — but it puts a defensible number on the bleeding side of the ledger, which is exactly what you want when you are counseling a family in the first tense minutes of a code stroke.1

Interactive tool

SEDAN Score Calculator

For an ischemic stroke patient being considered for IV thrombolysis. The score and estimated symptomatic-ICH risk update instantly.

Blood glucose S — blood Sugar
Early infarct signs on admission CT E
Hyperdense cerebral artery sign D — Dense artery
Age over 75 years A
NIHSS 10 or higher N
0 / 6
Lower risk

Educational tool only. The SEDAN Score estimates bleeding risk to inform a risk–benefit discussion; it is not a contraindication to thrombolysis and does not replace clinical judgment or eligibility criteria. Risk estimates from Strbian et al., Ann Neurol 2012 (derivation cohort).1

The five components

SEDAN is an acronym for its ingredients, all available before you push the drug. Each contributes points toward a total of 0 to 6.1

  • S — blood Sugar: 8.1–12.0 mmol/L (145–216 mg/dL) = 1 point; above 12.0 mmol/L (216 mg/dL) = 2 points.
  • E — Early infarct signs on the admission CT = 1 point.
  • D — (hyper)Dense cerebral artery sign on the admission CT = 1 point.
  • A — Age over 75 years = 1 point.
  • N — NIHSS of 10 or more = 1 point.

It is a deliberately spare list: a glucose value, two things the radiologist is already looking for, an age, and a severity number. Nothing here slows down a code stroke.

How the score maps to bleeding risk

In the original derivation cohort, the risk of symptomatic intracranial hemorrhage rose sharply and monotonically with the score — roughly 1.4% at 0, 2.9% at 1, 8.5% at 2, 12.2% at 3, 21.7% at 4, and 33.3% at 5. The validation cohort showed the same climbing pattern with slightly lower absolute numbers.1 The exact percentage matters less than the shape of the curve: each additional feature meaningfully raises the stakes.

Pitfall

A high SEDAN score is not a contraindication. The score quantifies bleeding risk only — it says nothing about the benefit the same patient stands to gain from reperfusion. Used as a treatment-exclusion rule, it will deny thrombolysis to people who would still come out ahead. It informs consent and vigilance, not a reflexive "no."

What the score does — and does not — tell you

What it does: give you a fast, evidence-based estimate of hemorrhage risk to share with the patient or family, and a reason to be especially attentive to post-thrombolysis blood pressure and neuro checks in higher-scoring patients. What it does not do: weigh the upside of treatment, account for thrombectomy candidacy, or override the standard eligibility criteria. It is one instrument in the risk assessment, tuned to a single question — how likely is a dangerous bleed — and it should be read as exactly that.

Limitations and external validation

SEDAN has been tested beyond its original cohort, and like every thrombolysis-bleeding score, its discrimination is modest rather than decisive — useful for stratifying groups, imprecise for any single patient. Different studies use different definitions of "symptomatic" hemorrhage, which shifts the absolute numbers. And the score predates the current era of wider thrombectomy and tenecteplase use, so it should be interpreted alongside up-to-date guidance rather than in a vacuum. Treat it as a well-validated prompt for caution, not a verdict.