Extended-window IVT requires salvageable tissue on advanced imaging: DWI/FLAIR mismatch or perfusion mismatch (core <70 mL, ratio ≥1.2). Also consider IVT for LVO 4.5–24 h when EVT is unavailable.
Absolute CI screen
Absolute Contraindications
Any item marked PRESENT = thrombolysis is absolutely contraindicated. Verify each is absent.
Relative Contraindications
2026 change: anticoagulation/bleeding disorder and recent surgery are now relative, decided by risk-benefit — not fixed exclusions. Present items need documented rationale and senior approval.
Flagged for chart documentation:
Class III — Do Not Thrombolyse
Pre-Procedure Checklist
✅ All checks complete
Attend continuously. Begin thrombolytic at the verified dose. Fastest door-to-needle wins.