Clinical Policy: Use of Intravenous Tissue Plasminogen Activator for the Management of Acute Ischemic Stroke in the Emergency Department

This clinical policy from the American College of Emergency Physicians is the revision of a clinical policy approved in 2012 addressing critical questions in the evaluation and management of patients with acute ischemic stroke.(1) A writing subcommittee conducted a systematic review of the literature to derive evidence-based recommendations to answer the following clinical questions: (1) Is intravenous tissue plasminogen activator safe and effective for patients with acute ischemic stroke if given within 3 hours of symptom onset? (2) Is intravenous tissue plasminogen activator safe and effective for patients with acute ischemic stroke treated between 3 to 4.5 hours after symptom onset? Evidence was graded and recommendations were made according to the strength of the available data.