Tenecteplase was superior to alteplase when given for acute ischemic stroke prior to thrombectomy.

For patients with unknown time of stroke onset, MRI characteristics may be able to discern the timing of the stroke and allow for thrombolytic therapy.  Overall, outcomes were better with thrombolysis but at the possible cost of higher mortality and risk of intracranial bleed.

The AHA released new 2018 guidelines, which are summarized for Emergency Physicians here.  The new guidelines are great, but at 345 pages in length you may want to read the short version.

Short Attention Span Summary In this meta-analysis focusing on time since TIA, early use of aspirin after TIA reduced the incidence of recurrent stroke at 6 weeks by 60%, NNT = 72.  The hazard ratio for those receiving aspirin vs control from 0-2 weeks was 0.07, NNT = 269.  This is a dramatically reduced risk. […]

Short Attention Span Summary Low dose (0.6mg/kg) tPA was found to be (barely) inferior to standard dose (0.9mg/kg) tPA in regard to the primary outcome of death or severe disability at 90 days, but there were fewer bleeds (1% vs 2.1%) in the low-dose group.  This was predominantly an Asian population, which limits generalizability. FOAM […]