What is the recommendation for administering IV alteplase in adult patients with disabling stroke symptoms?
The benefit of IV alteplase is well established for adult patients with disabling stroke symptoms regardless of age and stroke severity. When a patient cannot provide consent (eg, aphasia, confusion) and a legally authorized representative is not immediately available to provide proxy consent, it is justified to proceed with IV alteplase in an otherwise eligible adult patient with a disabling AIS. Physicians should review the criteria outlined in Table 8 to determine patient eligibility. IV alteplase (0.9 mg/kg, maximum dose 90 mg over 60 minutes with initial 10% of dose given as bolus over 1 minute) is also recommended for selected patients who can be treated within 3 and 4.5 hours of ischemic stroke symptom onset or patient last known well or at baseline state.