Acute Ischemic Stroke IV Thrombolysis Decision — free guideline decision tool

Screen acute ischemic stroke for IV thrombolysis from the time window and the absolute contraindications, with the alteplase/tenecteplase dose. Instant, browser-side.

Time window ≤ 3 h or 3–4.5 h is potentially eligible; > 4.5 h or unknown is outside the standard window. Any one absolute contraindication (intracranial hemorrhage/structural lesion, recent stroke/trauma/intracranial surgery, active bleeding/recent surgery, coagulopathy/anticoagulant, BP not controlled to < 185/110 mmHg, glucose < 2.8 or > 22.2) makes thrombolysis inappropriate.

Rapid bedside screening of IV thrombolysis indication and contraindications in acute ischemic stroke.

The 2026 AHA/ASA guideline, Table 7, lists: alteplase 0.9 mg/kg (max 90 mg), 10% as a bolus over 1 min and the rest infused over 60 min; tenecteplase 0.25 mg/kg (max 25 mg) as a single bolus. BP above 185/110 mmHg (2026 AHA/ASA §4.3, recommendation 5) and glucose derangement are correctable contraindications — lower BP with labetalol/nicardipine and recheck, correct glucose and recheck. Outside the standard window, assess for endovascular thrombectomy (anterior-circulation LVO up to 6–24 h) or individualise with multimodal imaging. Time is brain — minimise door-to-needle delay. US 2026 AHA/ASA guideline, Table 8 (relative contraindication; wording as amended by the 2026 correction): “Recent major non-CNS trauma within 14 days and 3 months” — “Patients with recent major trauma within 14 days of their AIS may be at increased risk of harm and serious systemic hemorrhage requiring transfusion from IV thrombolysis. Individual consideration of risk vs benefit, involved areas, and consultation with surgical experts are appropriate.” (English original authoritative, pending re-verification) US 2026 AHA/ASA guideline, Table 8 (absolute contraindication; wording as amended by the 2026 correction): “CT with extensive hypodensity” — “IV thrombolysis should not be administered to patients whose brain imaging exhibits extensive regions of clear hypodensity that appear to be responsible for the clinical symptoms of stroke. Clear hypodensity is when the degree of hypodensity is greater than the density of contralateral unaffected white matter.” (English original authoritative, pending re-verification) Relative contraindications [Pending update].

For licensed clinicians and clinical researchers. Interpret results with history, investigations and local protocols; not a diagnosis or prescription, and not a substitute for multidisciplinary decision-making or local guidelines.

Calculation runs locally in the browser; inputs and results are not uploaded. For licensed clinicians only; interpret with history, investigations and local protocols — not a diagnosis or prescription.

Inputs: Onset to treatment time 3–4.5 hours, History of intracranial hemorrhage / suspected SAH / intracranial tumour·aneurysm·AVM Yes, Stroke or severe head trauma in past 3 months / recent intracranial or intraspinal surgery Yes, Active internal bleeding / recent major surgery or non-compressible puncture Yes, Platelets < 100×10⁹/L / INR > 1.7 / low-molecular-weight heparin within 24 h, or thrombin/factor Xa inhibitor within 48 h Yes, BP cannot be lowered to < 185/110 mmHg Yes, Glucose < 2.8 or > 22.2 mmol/L Yes → Result: Thrombolysis decision Contraindicated（Time window: 3–4.5h, Contraindications hit: hemorrhage/intracranial structural contraindication; recent stroke/head trauma/intracranial surgery; active bleeding/recent surgery or puncture; Platelets < 100×10⁹/L / INR > 1.7 / low-molecular-weight heparin within 24 h, or thrombin/factor Xa inhibitor within 48 h; BP not controlled to < 185/110 mmHg; glucose < 2.8 or > 22.2, Basis: 2026 AHA/ASA (doses Table 7; BP §4.3 recommendations 5, 7); contraindications per the 2023 Chinese guideline [Unverified]） Inputs: Onset to treatment time > 4.5 hours or unknown, History of intracranial hemorrhage / suspected SAH / intracranial tumour·aneurysm·AVM No, Stroke or severe head trauma in past 3 months / recent intracranial or intraspinal surgery No, Active internal bleeding / recent major surgery or non-compressible puncture No, Platelets < 100×10⁹/L / INR > 1.7 / low-molecular-weight heparin within 24 h, or thrombin/factor Xa inhibitor within 48 h No, BP cannot be lowered to < 185/110 mmHg No, Glucose < 2.8 or > 22.2 mmol/L No → Result: Thrombolysis decision Outside standard window（Time window: > 4.5h or unknown, Recommendation: Beyond the standard alteplase/tenecteplase window; assess for endovascular thrombectomy, or individualise with multimodal-imaging guidance, Basis: 2026 AHA/ASA (doses Table 7; BP §4.3 recommendations 5, 7); contraindications per the 2023 Chinese guideline [Unverified]）