Treatment of Acute Ischemic Stroke with Disabling Neurological Deficits in Adults Presenting Within 4.5 Hours

Clinical Scenario

This protocol applies to adults aged 18 years and older presenting with acute ischemic stroke and disabling neurological deficits within 4.5 hours of symptom onset — or of last known well — who are eligible for intravenous thrombolysis.

Why Timing Is Critical

In adults with acute ischemic stroke who have disabling deficits and are eligible for intravenous thrombolytic therapy, faster treatment is directly associated with better functional outcomes — irrespective of stroke severity score. Every minute within the treatment window matters.

Treatment Approach

The protocol centres on intravenous thrombolytic therapy, with specific blood pressure thresholds that must be achieved before treatment is initiated and maintained for a defined period afterward.

Agent selection, dosing, sequence, and full monitoring parameters are available in the complete protocol.

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.1161/STR.0000000000000513

In adult patients with AIS presenting within 4.5 hours of symptom onset or last known well and eligible for IVT, tenecteplase at a dose of 0.25 mg/kg body weight (max 25 mg) or alteplase at a dose of 0.9 mg/kg body weight is recommended to improve functional outcomes.
In adult patients with AIS with disabling deficits, regardless of NIHSS score, and eligible for IVT, faster treatment improves functional outcomes.
Patients with AIS who have elevated BP and are otherwise eligible for treatment with IVT should have their SBP lowered to <185 mm Hg and diastolic blood pressure (DBP) <110 mm Hg before IVT therapy is initiated to reduce hemorrhagic complications.
BP should be maintained at <180/105 mm Hg for at least the first 24 hours after IVT treatment.

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