Diagnosis of<unk><unk>  causing measurable neuro deficit
Clear onset (last witnessed well) <3hr (see below for extension to <4.5hr)
Age >18yr
Historical<unk>  or head trauma in previous 3 months
Any history of intracranial hemorrhage
Major surgery in the previous 14 days
GI or urinary tract bleeding in previous 21 days
Myocardial infarction in previous 3 months
Arterial puncture at noncompressible site in previous 7 days
Clinical
Spontaneously clearing<unk>  symptoms
Only minor and isolated neurologic signs
Seizure at<unk>  onset
Persistent SBP >185 or DBP >110 despite treatment
Use of direct thrombin inhibitors (e.g. dabigatran, argatroban) or direct factor Xa inhibitors (e.g. rivaroxaban, apixaban) with elevated aPTT, INR, or factor Xa assay
Active bleeding or<unk>  trauma (fracture) on exam
Labs
Platelets <100K
Serum glucose <50, >400
INR >1.7 or PT >15 sec if on warfarin
Elevated PTT if on heparin
Head CT
Evidence of hemorrhage
Evidence of multilobar infarction with hypodensity involving >33% of cerebral hemisphere
Intracranial neoplasm, AVM, or aneurysm
Use of dabigatran within 48hrs is relative contraindication<unk>  or head trauma in previous 3 months
Any history of intracranial hemorrhage
Major surgery in the previous 14 days
GI or urinary tract bleeding in previous 21 days
Myocardial infarction in previous 3 months
Arterial puncture at noncompressible site in previous 7 days
Spontaneously clearing<unk>  symptoms
Only minor and isolated neurologic signs
Seizure at<unk>  onset
Platelets <100K
Serum glucose <50, >400
INR >1.7 or PT >15 sec if on warfarin
Elevated PTT if on heparin
Evidence of hemorrhage
Evidence of multilobar infarction with hypodensity involving >33% of cerebral hemisphere
Intracranial neoplasm, AVM, or aneurysm
Minor or rapidly improving<unk>  symptoms
Pregnancy
Seizure at onset with postictal residual neuro impairments
Thrombolytics for acute ischemic stroke
Thrombolytics for STEMI
Thrombolytics for pulmonary embolism
Anti-platelet agent reversal
Antiplatelet medications
Dabigatran reversal
Cardiovascular antibiotics
Low molecular weight heparin