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Because of rapid changes in the evidence, the AHA/ASA has updated its acute stroke guidelines from 2018, which in turn replaced the 2013 guidelines.
New recommendations include the following:
IV alteplase may be helpful when administered within 4.5 hours of stroke symptom recognition in patients with acute ischemic stroke (AIS) who awake with stroke symptoms or have onset time of uncertain timing but >4.5 hours from last known well, when the DW-MRI lesion is smaller than one third of the middle cerebral artery territory and FLAIR shows no signal change (Class of Recommendation [COR] IIa).
Patients with mild, nondisabling stroke symptoms…