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    Intravenous tPA For Acute Ischemic Stroke (beta)

    Official guideline from the American College of Emergency Physicians.

    summary by Eric Steinberg, DO

    Recommendations

    0-3 Hours

    Level B

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    Level C

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    3-4.5 Hours

    Level B

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    Level C

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    Level A
    Generally accepted principles for patient care that reflect a high degree of clinical certainty (ie, based on evidence from 1 or more Class of Evidence I or multiple Class of Evidence II studies).
    Level B
    Recommendations for patient care that may identify a particular strategy or range of strategies that reflect moderate clinical certainty (ie, based on evidence from 1 or more Class of Evidence II studies or strong consensus of Class of Evidence III studies).
    Level C
    Recommendations for patient care that are based on evidence from Class of Evidence III studies or, in the absence of any adequate published literature, based on expert consensus. In instances where consensus recommendations are made, “consensus” is placed in parentheses at the end of the recommendation.

    Brown MD, Burton JH, Nazarian DJ, et al. American College of Emergency Physicians. Clinical Policy: Use of Intravenous Tissue Plasminogen Activator for the Management of Acute Ischemic Stroke in the Emergency Department. Ann Emerg Med. 2015;66(3):322-333.e31.