Acute Ischemic Stroke 

May 5, 2023


Tenecteplase 0.25 mg/kg is recommended over alteplase 0.9 mg/kg for large vessel occlusion AIS patients that are candidates to mechanical thrombectomy

For patients with acute ischaemic stroke of < 4.5 h duration and with large vessel occlusion who are candidates for mechanical thrombectomy and for whom intravenous thrombolysis is considered before thrombectomy, we suggest intravenous thrombolysis with tenecteplase 0.25 mg/kg over intravenous thrombolysis with alteplase 0.9 mg/kg (7).

Tenecteplase versus alteplase for AIS not eligible to mechanical thrombectomy

American Stroke Association

IV alteplase recommendations (2)

European Stroke Organization

Summary of recommendations on tenecteplase for AIS (7)

Webinar presentation of ESO Expedited Recommendation on Tenecteplase for Acute Ischaemic Stroke by S. Alamowitch. February 2, 2023. 

Contraindications to fibrinolytic therapy

There is not a definite and universally accepted list of contraindications to fibrinolytic therapy, and there seems to be a tendency for it to become simpler over the years. Please be aware that references may differ on certain issues:

Absolute contraindications (1, 2, 3)


Relative contraindications (1, 2, 3)

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