23
4.6.1. Thrombolysis Decision-Making
COR LOE
Recommendations
General Principles (cont'd)
3: No
benefit
B-R
8. In eligible adult patients with AIS presenting with mild
non-disabling stroke deficits (eg, isolated sensory syndrome
in many cases) within 4.5 hours of symptom onset or last
known well, IVT is not recommended as it has not shown
superiority in improving functional outcomes compared to
double antiplatelet treatment.
Bleeding Risk
1 B-NR
9. In suspected patients with AIS who are taking single or DAPT
and are otherwise eligible for IVT, IVT is recommended to
improve functional outcomes despite an increase in risk of
sICH compared with no antiplatelet therapy.
2a B-NR
10. In patients with AIS within 4.5 hours of last known well and
eligible for IVT, it is reasonable that IVT not be delayed
while waiting for hematologic or coagulation testing if there
is no reason to suspect an abnormal result.
1 B-NR
11. In patients with AIS who are eligible for IVT within 4.5
hours of symptom onset with unknown burden of cerebral
microbleeds (CMB), it is recommended that IVT be
administered without first obtaining MRI to exclude CMBs.
2a B-NR
12. In patients with AIS within 4.5 hours of last known well and
who are eligible for IVT, administration of IVT is reasonable
to achieve better functional outcomes if a small number (e.g,
1–10) of CMBs was demonstrated on MRI.
2b B-NR
13. In patients with AIS within 4.5 hours of last known well and
who are eligible for IVT, if they previously had a high burden
(eg, >10) of CMBs demonstrated on MRI, usefulness of IVT is
uncertain as it may be associated with an increased risk of sICH.
Pediatric Patients
2b C-LD
14. In pediatric patients aged 28 days to 18 years with confirmed
AIS presenting within 4.5 hours of symptom onset and
disabling deficits, IVT with alteplase may be considered as it
is safe, but efficacy is uncertain.
(cont'd)
