What are the American Heart Association (AHA) recommendations for use of IV alteplase for thrombolytic therapy of acute ischemic stroke (AIS)?

Updated: Aug 04, 2021
  • Author: Wanda L Rivera-Bou, MD, FAAEM, FACEP; Chief Editor: Erik D Schraga, MD  more...
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The FDA has not yet approved IV alteplase for use beyond 3 hours. In 2009, The American Heart Association and the American Stroke Association published a scientific advisory statement recommending its use 3 to 4.5 hours from AIS symptom onset for eligible patients without contraindications. [56]

Ideally, patients should arrive at an institution with a stroke center. The time of symptom onset must be well established (< 4.5 hours), and the patient must be presenting with a measurable neurologic deficit. Stroke severity must be assessed with the NIH stroke scale (maximum score, 42).

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