Do we need echocardiography before commencing thrombolytic therapy?

We report a case of a 41-year-old man who had fatal multiple cerebral and bilateral renal infarcts 1 hour after initiation of thrombolytic therapy for acute ST elevation myocardial infarction. Echocardiography study disclosed dilated left ventricle with severe global hypokinesia suggestive of preexisting cardiomyopathy and a disintegrated left ventricular apical thrombus pointing out to the source of the embolic complication. This raises the question whether echocardiography before initiating thrombolytic therapy would affect the decision of commencing thrombolytic therapy and help avoiding such lethal embolic complications.