1.4 Pharmacological treatments and thrombectomy for people with acute stroke Thrombolysis with alteplase for people with acute ischaemic stroke 1.4.1 Alteplase is recommended within its marketing authorisation for treating acute ischaemic stroke in adults if: treatment is started as soon as possible within 4.5 hours of onset of stroke symptoms and intracranial haemorrhage has been excluded by appropriate imaging This recommendation is from NICE's technology appraisal guidance on alteplase for treating acute ischaemic stroke. 1.4.2 Administer alteplase only within a well-organised stroke service with: staff trained in delivering thrombolysis and in monitoring for any complications associated with thrombolysis 2022 nursing staff trained in acute stroke and thrombolysis to provide level 1 and level 2 care (seen the NHS Data Model and Dictionary on critical care level) immediate access to imaging and re-imaging, and staff trained to interpret the 1.4.3 Staff in emergency departments, if appropriately trained and supported, can administer alteplase for the treatment of ischaemic stroke provided that patients can be managed within an acute stroke service with appropriate neuroradiological and stroke physician support. [2008] 1.4.4 Ensure that protocols are in place for delivering and managing intravenous thrombolysis, including post-thrombolysis complications. 