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Guidelines From the American Heart Association and American Academy of Neurology Regarding Use of t-PA to Treat Ischemic Stroke   9-1999                                                             

Intravenous recombinant t-PA (0.9 mg/kg, max. 90 mg, with 10% of the dose given as a bolus followed by a 60-minute infusion) was recommended for patients who meet all of the following criteria:

t-PA should not be used more than three hours after stroke onset or when the time of onset cannot reliably be determined

t-PA should be used with caution in patients with severe stroke (NIH Stroke Scale score > 22)

If possible, the risks should be discussed with the patient and family prior to treatment

t-PA should be administered only if emergent ancillary care and the facilities to handle bleeding complications are readily available, including:

After treatment, patients should not be given aspirin, heparin, warfarin, ticlopidine, or other antithrombotic or antiplatelet drugs for at least 24 hours

Intravenous streptokinase is not recommended for use outside of clinical trials in managing acute ischemic stroke

Intra-arterial thrombolysis warrants further study. In the meantime, it should be considered investigational and used only in clinical trials by physicians experienced with neurointervention techniques working in centers with neurological expertise


Adams HP, Brott TG, Furlan AJ, et al from a Special Writing Group of the Stroke Council, American Heart Association. Guidelines for thrombolytic therapy for acute stroke: a supplement to the guidelines for the management of patients with acute ischemic stroke. Available at:   www.Americanheart.org

Accessed September 6, 1999.