🧠 Acute Ischemic Stroke IV Thrombolysis Decision
Screen acute ischemic stroke for IV thrombolysis from the time window and the absolute contraindications, with the alteplase/tenecteplase dose. Instant, browser-side.
Acute Ischemic Stroke IV Thrombolysis Decision
Onset to treatment time
History of intracranial hemorrhage / suspected SAH / intracranial tumour·aneurysm·AVM
Stroke or severe head trauma in past 3 months / recent intracranial or intraspinal surgery
Active internal bleeding / recent major surgery or non-compressible puncture
Platelets < 100×10⁹/L / INR > 1.7 / heparin within 48h / direct anticoagulant
BP > 185/110 mmHg and uncontrollable
Glucose < 2.8 or > 22.2 mmol/L
When to use
Rapid bedside screening of IV thrombolysis indication and contraindications in acute ischemic stroke.
How it works
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.
Key points
- 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.
References
Decision support for licensed clinicians only; not a substitute for clinical judgement, diagnosis or local protocols.