Recommendations

Document Overview

Design and created by Guideline Central in participation with the American College of Emergency Physicians.

Use of Intravenous tPA for the Management of Acute Ischemic Stroke in the Emergency Department

American College of Emergency Physicians

Publication Date: Sep 1, 2015

Page Last Updated: May 5, 2026

American Physical Therapy Association Evidence Grading System

Grade of Evidence
Grade	Recommendation	Description
A	Strong	A preponderance of level I and/or level II studies supports the recommendation, This must include at least 1 level I study.
B	Moderate	A single high-quality randomized controlled trial or a preponderance of level II evidence supports the recommendation.
C	Weak	A single level II study or a preponderance of level II and TV studies supports the recommendation.
D	Conflicting	Higher-quality studies conducted on this topic disagree with respect to their conclusions. The recommendation is based on these conflicting studies.
E	Theoretical/foundational	A preponderance of evidence from animal or cadaver studies, from conceptual models/principles or from basic science/bench research supports this conclusion.
F	Expert opinion	Best practice based on the clinical experience of the guidelines development team.

Document Overview

Document Title: Use of Intravenous tPA for the Management of Acute Ischemic Stroke in the Emergency Department

Authoring Society: American College of Emergency Physicians

Document Publication Date: Sep 1, 2015

Page Last Reviewed/Updated: May 5, 2026

Document Type: Guideline

Country of Publication: United States

Full Text Freely Available: No

Full Text Guideline: www.doi.org/10.1016/j.annemergmed.2015.06.031

Source Citation: Ann Emerg Med. 2015;66:322-333.

Supplemental Implementation Resources

Document Scope, Criteria, and Use Cases

Document Objectives: This clinical policy from the American College of Emergency Physicians is the revision of a clinical policy approved in 2012 addressing critical questions in the evaluation and management of patients with acute ischemic stroke

Scope: Assessment and Screening, Management, Treatment

Diseases/Conditions (MeSH)

D010959 - Tissue Plasminogen Activator

D010960 - Plasminogen Activators

D002545 - Brain Ischemia

D020521 - Stroke

Keywords: Acute Ischemic Stroke, plasminogen activator, t-pa

Target Patient Population: Patients with acute ischemic stroke

Inclusion Criteria: Female, Male, Adolescent, Adult, Older Adult

Health Care Settings: Emergency Care

Intended Users: Nurse, Nurse Practitioner, Paramedic/EMT, Physician, Physician Assistant

Recommendation Development Processes & Methodology

Number of Source Documents: 100

Literature Search Start Date: Saturday, January 1, 2011

Literature Search End Date: Wednesday, September 3, 2014

Includes peer/external review process?: Yes

Includes public comment process?: No

Methodologist involvement?: Yes

Patient involvement?: Yes

Includes multi-disciplinary group?: Yes

Includes systematic review?: Yes

Grades quality of strength of evidence?: Yes

Grades quality of strength of recommendation?: Yes

Includes benefits/harms analysis with recommendations?: Yes

Use of Intravenous tPA for the Management of Acute Ischemic Stroke in the Emergency Department

Recommendations

Patient Management

American Physical Therapy Association Evidence Grading System

Document Overview

Supplemental Implementation Resources

Document Scope, Criteria, and Use Cases

Recommendation Development Processes & Methodology