For patients presenting with moderate AIS likely to produce mild disability and acute pericarditis, treatment with IV alteplase is of uncertain net benefit. (COR IIb; LOE C-EO) Left atrial or ventricular thrombus For patients with major AIS likely to produce severe disability and known left atrial or ventricular thrombus, treatment with IV alteplase may be reasonable. (COR IIb; LOE C-LD) For patients presenting with moderate AIS likely to produce mild disability and known left atrial or ventricular thrombus, treatment with IV alteplase is of uncertain net benefit. (COR IIb; LOE C-LD) Other cardiac diseases For patients with major AIS likely to produce severe disability and cardiac myxoma, treatment with IV alteplase may be reasonable. (COR IIb; LOE C-LD) For patients presenting with major AIS likely to produce severe disability and papillary fibroelastoma, treatment with IV alteplase may be reasonable. (COR IIb; LOE C-LD) Procedural stroke IV alteplase is reasonable for the treatment of AIS complications of cardiac or cerebral angiographic procedures, depending on the usual eligibility criteria. (COR IIa; LOE A) Table 8. Continued (Continued) Powers et al 2019 Guidelines for Management of AIS e369 Table 8. Continued Systemic malignancy The safety and efficacy of IV alteplase in patients with current malignancy are not well established. (COR IIb; LOE C-LD) Patients with systemic malignancy and reasonable (>6 mo) life expectancy may benefit from IV alteplase if other contraindications such as coagulation abnormalities, recent surgery, or systemic bleeding do not coexist. Pregnancy IV alteplase administration may be considered in pregnancy when the anticipated benefits of treating moderate or severe stroke outweigh the anticipated increased risks of uterine bleeding. (COR IIb; LOE C-LD) The safety and efficacy of IV alteplase in the early postpartum period (<14 d after delivery) have not been well established. 