Because time from onset of symptoms to treatment has such a powerful impact on outcomes, treatment with IV alteplase should not be delayed to monitor for further improvement. III: Harm C-EO Recommendation wording modified from 2015 IV Alteplase to match COR III stratifications and reworded for clarity. COR and LOE amended to conform with ACC/AHA 2015 Recommendation Classification System. See Table XCV in online Data Supplement 1 for original wording. 3.5.2. Time Windows COR LOE New, Revised, or Unchanged IV alteplase (0.9 mg/kg, maximum dose 90 mg over 60 minutes with initial 10% of dose given as bolus over 1 minute) is recommended for selected patients who can be treated within 3 hours of ischemic stroke symptom onset or patient last known well or at baseline state. Physicians should review the criteria outlined in Table 8 to determine patient eligibility. I A Recommendation reworded for clarity from 2013 AIS Guidelines. COR and LOE unchanged. See Table XCV in online Data Supplement 1 for original wording. The safety and efficacy of this treatment when administered within the first 3 hours after stroke onset are solidly supported by combined data from multiple RCTs155 157 and confirmed by extensive community experience in many The eligibility criteria for IV alteplase have evolved over time as its usefulness and true risks have become clearer. A recent AHA statement provides a detailed discussion of this topic.14 Eligibility recommendations for IV alteplase in patients with AIS are summarized in Table 8. 