sICH rates were 1% in both groups. See Table XLIII in online Data Supplement 1. Tenecteplase administered as a 0.4-mg/kg single IV bolus has not been proven to be superior or noninferior to alteplase but might be considered as an alternative to alteplase in patients with minor neurological impairment and no major intracranial occlusion. IIb B-R New recommendation. IV tenecteplase has been compared with IV alteplase up to 6 hours after stroke onset in 3 phase II and 1 phase III superiority trials; tenecteplase appears to be similarly safe, but it is unclear whether it is as effective as or more effective than alteplase.179 182 In the largest trial of 1100 subjects, tenecteplase at a dose of 0.4 mg/kg failed to demonstrate superiority and had a safety and efficacy profile similar to that of alteplase in a stroke population composed predominantly of patients with minor neurological impairment (median NIHSS score, 4) and no major intracranial occlusion.182 Tenecteplase is given as a single IV bolus as opposed to the 1-hour infusion of alteplase. See Table XLIII in online Data Supplement 1. The administration of IV defibrinogenating agents or IV fibrinolytic agents other than alteplase and tenecteplase is not recommended. III: No Benefit B-R Recommendation revised from 2013 AIS Guidelines. Randomized placebo-controlled trials have not shown benefit from the administration of IV streptokinase within 6 hours or desmoteplase within 3 to 9 hours after stroke onset in patients with ischemic penumbra, large intracranial artery occlusion, or severe stenosis.155,183 186 See Table XLIII in online Data Supplement 1. The use of sonothrombolysis as adjuvant therapy with IV fibrinolysis is not recommended. III: No Benefit A New recommendation. Since the publication of the 2013 AIS Guidelines, 2 RCTs of sonothrombolysis as adjuvant therapy for IV thrombolysis have shown no clinical benefit. 