Acute Ischemic Stroke IV Thrombolysis Decision — free guideline decision tool

Screen acute ischemic stroke for IV thrombolysis from the time window and the absolute contraindications, with the alteplase/tenecteplase dose. Instant, browser-side.

Time window ≤ 3 h or 3–4.5 h is potentially eligible; > 4.5 h or unknown is outside the standard window. Any one absolute contraindication (intracranial hemorrhage/structural lesion, recent stroke/trauma/intracranial surgery, active bleeding/recent surgery, coagulopathy/anticoagulant, BP > 185/110 uncontrolled, glucose < 2.8 or > 22.2) makes thrombolysis inappropriate.

Rapid bedside screening of IV thrombolysis indication and contraindications in acute ischemic stroke.

Within the window and with no listed absolute contraindication: alteplase 0.9 mg/kg (max 90 mg, 10% bolus then infusion over 1 h) or tenecteplase 0.25 mg/kg (max 25 mg) bolus. BP > 185/110 and glucose derangement are correctable contraindications — lower BP with labetalol/nicardipine and recheck, correct glucose and recheck. Outside the standard window, assess for endovascular thrombectomy (anterior-circulation LVO up to 6–24 h) or individualise with multimodal imaging. Time is brain — minimise door-to-needle delay.

For licensed clinicians and clinical researchers. Interpret results with history, investigations and local protocols; not a diagnosis or prescription, and not a substitute for multidisciplinary decision-making or local guidelines.

Inputs: Onset to treatment time ≤ 3 hours, History of intracranial hemorrhage / suspected SAH / intracranial tumour·aneurysm·AVM Yes, Stroke or severe head trauma in past 3 months / recent intracranial or intraspinal surgery Yes, Active internal bleeding / recent major surgery or non-compressible puncture Yes, Platelets < 100×10⁹/L / INR > 1.7 / heparin within 48h / direct anticoagulant Yes, BP > 185/110 mmHg and uncontrollable Yes, Glucose < 2.8 or > 22.2 mmol/L Yes → Result: Thrombolysis decision Contraindicated（Time window: ≤ 3h, Contraindications hit: hemorrhage/intracranial structural contraindication; recent stroke/head trauma/intracranial surgery; active bleeding/recent surgery or puncture; coagulation/anticoagulant contraindication; BP > 185/110 uncontrolled; glucose < 2.8 or > 22.2, Basis: Chinese Guidelines for Acute Ischemic Stroke 2023） Inputs: Onset to treatment time > 4.5 hours or unknown, History of intracranial hemorrhage / suspected SAH / intracranial tumour·aneurysm·AVM No, Stroke or severe head trauma in past 3 months / recent intracranial or intraspinal surgery No, Active internal bleeding / recent major surgery or non-compressible puncture No, Platelets < 100×10⁹/L / INR > 1.7 / heparin within 48h / direct anticoagulant No, BP > 185/110 mmHg and uncontrollable No, Glucose < 2.8 or > 22.2 mmol/L No → Result: Thrombolysis decision Outside standard window（Time window: > 4.5h or unknown, Recommendation: Beyond the standard alteplase/tenecteplase window; assess for endovascular thrombectomy, or individualise with multimodal-imaging guidance, Basis: Chinese Guidelines for Acute Ischemic Stroke 2023）