The efficacy of the IV glycoprotein IIb/IIIa inhibitors tirofiban and eptifibatide coadministered with IV alteplase is not well established. IIb B-R Recommendation revised from 2013 AIS Guidelines. Single-arm studies of eptifibatide as adjunctive therapy to IV alteplase support ongoing RCTs to establish safety and Further clinical trials are needed. See Table XXXIX in online Data Supplement 1. 5. Abciximab should not be administered concurrently with IV alteplase. III: Harm B-R Recommendation reworded for clarity from 2015 IV Alteplase. COR and LOE amended to conform with ACC/AHA 2015 Recommendation Classification System. See Table XCV in online Data Supplement 1 for original wording. IV aspirin should not be administered within 90 minutes after the start of IV alteplase. III: Harm B-R New recommendation. The ARTIS trial (Antiplatelet Therapy in Combination with rt-PA Thrombolysis in Ischemic Stroke) compared the effects of very early addition (within 90 minutes) of 300 mg IV aspirin to alteplase with standard treatment with alteplase without IV aspirin.175 The trial was terminated after 642 of the 800 targeted patients had been enrolled because IV aspirin was associated with an increased risk of symptomatic intracranial hemorrhage (4.3% versus 1.6% in the standard treatment group; RR, 2.78 [95% CI, 1.01 7.63]; P=0.04) and no difference in the rate of favorable functional outcome (mRS score 0 2) at 3 months (54.0% of patients in the aspirin group versus 57.2% of patients in the standard treatment group; RR, 0.94 [95% CI, 0.82 1.09]; P=0.42). See Table XL in online Data Supplement 1. Powers et al 2019 Guidelines for Management of AIS e365 IV alteplase should not be administered to patients who have received a full treatment dose of low-molecular-weight heparin (LMWH) within the previous 24 hours. III: Harm B-NR Recommendation reworded for clarity from 2015 IV Alteplase. 