Clinical Policy: Use of intravenous tPA for the management of acute ischemic stroke in the emergency department

Ann Emerg Med. 2013 Feb;61(2):225-43. doi: 10.1016/j.annemergmed.2012.11.005.


This policy was developed by a joint writing panel of the American College of Emergency Physicians and the American Academy of Neurology. The panel reviewed the literature to derive evidence-based recommendations to help clinicians answer the following critical questions: (1) Is intravenous tissue plasminogen activator (tPA) safe and effective for acute ischemic stroke patients if given within 3 hours of symptom onset? (2) Is intravenous tPA safe and effective for acute ischemic stroke patients treated between 3 to 4.5 hours after symptom onset? Evidence was graded and recommendations were given based on the strength of the available data in the medical literature.

Publication types

  • Practice Guideline

MeSH terms

  • Administration, Intravenous
  • Age Factors
  • Aged
  • Aged, 80 and over
  • Emergency Service, Hospital / standards*
  • Fibrinolytic Agents / administration & dosage
  • Fibrinolytic Agents / therapeutic use*
  • Glasgow Coma Scale
  • Humans
  • Stroke / drug therapy*
  • Time Factors
  • Tissue Plasminogen Activator / administration & dosage
  • Tissue Plasminogen Activator / therapeutic use*
  • Treatment Outcome


  • Fibrinolytic Agents
  • Tissue Plasminogen Activator