Nasal-tracheal intubation may be required but poses risk of epistaxis after IV alteplase. Cricothyroidotomy is rarely needed and also problematic after IV alteplase. Discontinue IV alteplase infusion and hold ACE inhibitors Administer IV methylprednisolone 125 mg Administer IV diphenhydramine 50 mg Administer ranitidine 50 mg IV or famotidine 20 mg IV If there is further increase in angioedema, administer epinephrine (0.1%) 0.3 mL subcutaneously or by nebulizer 0.5 mL Icatibant, a selective bradykinin B2 receptor antagonist, 3 mL (30 mg) subcutaneously in abdominal area; additional injection of 30 mg may be administered at intervals of 6 h not to exceed a total of 3 injections in 24 h; and plasma-derived C1 esterase inhibitor (20 IU/kg) has been successfully used in hereditary angioedema and ACE inhibitor-related angioedema Supportive care ACE indicates angiotensin-converting enzyme; AIS, acute ischemic stroke; COR, class of recommendation; IV, intravenous; and LOE, Level of Evidence. Sources: Foster-Goldman and McCarthy,147 Gorski and Schmidt,148 Lin et al,150 Correia et al,151 O Carroll and Aguilar,152 Myslimi et al,153 and Pahs Table 8. Eligibility Recommendations for IV Alteplase in Patients With AIS Indications (COR I) Within 3 h* IV alteplase (0.9 mg/kg, maximum dose 90 mg over 60 min with initial 10% of dose given as bolus over 1 min) is recommended for selected patients who may be treated within 3 h of ischemic stroke symptom onset or patient last known well or at baseline state. Physicians should review the criteria outlined in this table to determine patient eligibility. (COR I; LOE A) Within 3 h Age For otherwise medically eligible patients 18 y of age, IV alteplase administration within 3 h is equally recommended for patients 80 and >80 y of age. 