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Despite fibrinolysis being recommended as a first-line treatment by most stroke associations, many practitioners remain hesitant to use it, partly because of concern about causing intracerebral hemorrhage. The Safe Implementation of Thrombolysis in Stroke-Monitoring Study, supported by the manufacturer of alteplase, was designed to assess the safety of intravenous alteplase therapy in clinical practice compared with that in pooled, randomized, controlled trials. In this prospective, observational study, patients aged 18 to 80 who presented within 3 hours of ischemic stroke onset with National Institutes of Health stroke scale scores <25 were eligible to receive IV alteplase (0.9 mg/kg). The researchers report outcomes for 6483 patients trea…