Stroke Thrombolysis Criteria

Patient Eligibility

The American Heart Association recommends that all eligible patients should receive IV alteplase within 3 hours of symptom onset or last known well 1, 2
Patients with mild symptoms may be considered if potentially disabling, as recommended by the American Stroke Association 3, 2
Patients with extensive early ischemic changes (>1/3 MCA territory) can still be treated within 3 hours, according to the American College of Cardiology 1
The American Stroke Association suggests that patients >80 years presenting in the 3-4.5 hour window can be treated with alteplase, despite older exclusion criteria 3, 1

The American Heart Association states that CT or MRI showing intracranial hemorrhage is an absolute contraindication for IV alteplase 2
History of intracranial hemorrhage is an absolute contraindication, as recommended by the American Stroke Association 5, 2
Active internal bleeding is an absolute contraindication, according to the American College of Cardiology 2

The American Heart Association recommends a dosing regimen of 0.9 mg/kg body weight (maximum 90 mg total) for IV alteplase 1, 2, 4
The American College of Cardiology suggests that door-to-needle time should be <60 minutes in 90% of patients, with a median target of 30 minutes 1, 2
Blood pressure must be lowered to <185/110 mmHg before initiating thrombolysis, as recommended by the American Stroke Association 1, 2, 4

The American Heart Association recommends that eligible patients should receive IV alteplase even if mechanical thrombectomy is being considered 1, 4
The American College of Cardiology suggests that patients with suspected large vessel occlusion should have non-invasive angiography (CTA) 1, 4

Delaying treatment for non-essential laboratory tests is a critical pitfall to avoid, as recommended by the American Stroke Association 1
Waiting to assess alteplase response before initiating thrombectomy evaluation is a critical pitfall to avoid, according to the American College of Cardiology 1, 4
Excluding patients >80 years in the 3-4.5 hour window is an outdated practice and should be avoided, as suggested by the American Heart Association 3, 1