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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
    Strength
    Level A
    Level B
    Level C

    Recommendations

    0-3 Hours
    1. With a goal to improve functional outcomes, intravenous tissue plasminogen activator (IV tPA) should be offered and may be given to selected patients with acute ischemic stroke within 3 hours after symptom onset at institutions where systems are in place to safely administer the medication. The increased risk of symptomatic intracerebral hemorrhage (sICH) should be considered when deciding whether to administer intravenous tissue plasminogen activator to patients with acute ischemic stroke.
    2. When feasible, shared decision-making between the patient (and/or his or her surrogate) and a member of the health care team should include a discussion of potential benefits and harms prior to the decision whether to administer intravenous tissue plasminogen activator (IV tPA) for acute ischemic stroke. [Consensus Recommendation]
    3-4.5 Hours
    1. Despite the known risk of symptomatic intracerebral hemorrhage (sICH) and the variability in the degree of benefit in functional outcomes, intravenous tissue plasminogen activator (IV tPA) may be offered and may be given to carefully selected patients with acute ischemic stroke within 3 to 4.5 hours after symptom onset at institutions where systems are in place to safely administer the medication.
    2. When feasible, shared decision-making between the patient (and/or his or her surrogate) and a member of the health care team should include a discussion of potential benefits and harms prior to the decision whether to administer intravenous tissue plasminogen activator (IV tPA) for acute ischemic stroke. [Consensus Recommendation]
    What do the icons mean?  
    Research PaperBrown 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.