ACEP Clinical Policy — Use of IV tPA for Acute Ischemic Stroke (2024)

The ACEP 2024 Clinical Policy on the use of intravenous thrombolytics (IV alteplase/tPA and tenecteplase) for acute ischemic stroke synthesizes evidence-based recommendations for patient selection, contraindications, dosing, and time windows. This decision tool guides emergency physicians through eligibility assessment and risk-benefit communication for IV thrombolysis in the acute stroke patient — the most time-critical intervention in emergency medicine ('Time is Brain': approximately 1.9 million neurons lost per minute of untreated ischemic stroke). Tenecteplase (TNK) is included as an evidence-based alternative to alteplase in most patients.