🧠 Acute Ischemic Stroke IV Thrombolysis Decision
UseRapid bedside screening of IV thrombolysis indication and contraindications in acute ischemic stroke.
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SourceChinese Guidelines for Diagnosis and Treatment of Acute Ischemic Stroke 2023 (Chinese Journal of Ne…
Runs locally in your browser (no PHI uploaded). For licensed clinicians — not a substitute for clinical judgement.
Stored on this device for revisit reminders
This-shift next steps
After scoring: open the scene pack, peer scores, and the matching pathway. Local reference — no HIS write.
- Who it is for
- Adults with suspected acute stroke when quantifying deficit and deciding reperfusion, or TIA when judging short-term risk.
- Who it is not for
- Do not use ABCD² to decide thrombolysis. No new stroke scale.
- Formula and variables
- NIHSS is the neurologic deficit; items stay as on this page. FAST-ED is a prehospital large-vessel screen. ABCD² is age, blood pressure, clinical features, duration, and diabetes, for TIA.
- Result → next step
- This scene links only to the three tools below: deficit and time window open the thrombolysis page. A positive large-vessel screen opens thrombectomy. Drugs after the acute phase open secondary prevention. Thrombolysis shows no number until weight, onset time, pregnancy, and recent anticoagulation are known. Anticoagulant-related intracranial bleeding goes to reversal and ICH management.No numeric dose until age, weight, renal function, and pregnancy are all known. Pregnancy is contraindication or caution only.Thrombectomy →Secondary prevention →
- Guideline and review date
- China acute ischemic stroke guideline 2023 + 2026 AHA/ASA · reviewed 2026-10-06
Score + version; reference only — not a substitute for care · no HIS write
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Methodology · worked example, guidelines & full notes
Clinical takeaway
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.
When to use
Rapid bedside screening of IV thrombolysis indication and contraindications in acute ischemic stroke.
How it works
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.
Key points
- 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].
References
- [Guideline / primary source]Chinese Guidelines for Diagnosis and Treatment of Acute Ischemic Stroke 2023 (Chinese Journal of Neurology)
- [Guideline / primary source]2026 AHA/ASA Guideline for the Early Management of Patients With Acute Ischemic Stroke (Prabhakaran S, et al. Stroke 2026;57(8); doi:10.1161/STR.0000000000000513), which replaces the 2018 guideline and its 2019 update
- [Guideline / primary source]Correction to: 2026 Guideline for the Early Management of Patients With Acute Ischemic Stroke: A Guideline From the AHA/ASA. Stroke 2026;57(8). doi:10.1161/STR.0000000000000530
Worked calculation
The values below come from this tool's own example placeholders and are computed server-side with the formula shown on this page, so the arithmetic can be checked quickly. It demonstrates how to substitute values only — it is not clinical advice and not a real case.
| 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 |
→Thrombolysis decisionContraindicated
- 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]
| 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 |
→Thrombolysis decisionOutside 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]
Verification & sources · governance
FAQ
Frequently asked questions
- What are the limits and cautions when using Acute Ischemic Stroke IV Thrombolysis Decision?
- 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.
- Does Acute Ischemic Stroke IV Thrombolysis Decision upload patient data? Where is it calculated?
- 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.
- How is Acute Ischemic Stroke IV Thrombolysis Decision calculated in practice? Can you show a worked example?
- 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]）