tPA is considered a gold standard for treatment of patients with ischemic strokes.

Mechanism: Works by dissolving clots and restoring/improving blood perfusion to part of the brain that was previously impeded.

Important: Differentiate ischemic and hemorrhagic stroke by administering CT scan. tPA will not be useful in hemorrhagic strokes as decreased perfusion to brain is result of intracranial bleeding as opposed to a vascular obstruction.

When to give: Must be given within 3-4.5 hours from onset of stroke symptoms. *NOTE: it is from the time the patient was last asymptomatic, hence if a patient awakes with stroke symptoms, they were last asymptomatic whatever time they fell asleep.

How is it administered: IV

REFERENCES

1. Davis SM, Donnan GA (June 2009). “4.5 hours: the new time window for tissue plasminogen activator in stroke”. Stroke 40 (6): 2266–7. 

2. Fonarow GC, Zhao X, Smith EE, et al. Door-to-Needle Times for Tissue Plasminogen Activator Administration and Clinical Outcomes in Acute Ischemic Stroke Before and After a Quality Improvement Initiative. JAMA. 2014;311(16):1632-1640. doi:10.1001/jama.2014.3203. 

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