Sudden onset focal neuro deficit Onset < 4.5 hours from last known normal
Exclusion Criteria – History
Stroke, or severe head injury past 3 months Previous intracranial bleed Intraaxial brain tumor GI malignancy GI bleed < 21 days
Exclusion Criteria – Clinical
Possible Subarachnoid hemorrhage Systolic BP > 185 despite Rx Active internal bleed Possible infective endocarditis Aortic dissection Acute bleeding or bleeding tendency
Exclusion Criteria – Hematologic
Platelets < 100K INR > 1.7, or PTT > 40 seconds Therapeutic dose use of low molecular weight heparin < 24 hours NOAC use < 48 hours
Exclusion Criteris – Head CT
Bleed large are of low density
Warnings – Others
Minor stroke or rapidly improving Glucose < 50 (< 2.8 mmol/L) Severe trauma or major surgery < 14 days history og GI, GU bleed Seizure at onset of stroke Artery puncture at noncompressible site < 7 days Cerebral AVM Cerebral aneurysm > 10 mm
Warnings if over 3 hours
Age > 80 Oral anticoagulant regardless of INR NIHSS > 25 Previous Stroke + DM