On June 2015 ACEP updated the 2013 policy on ischemic stroke treatment.
The 2013 policy graded the tPA administration within 3 hours as a Level A recommendation and tPA administration between 3 to 4.5 hours as Level Brecommendation
In Jan 2015 ACEP published a Draft about the update of the 2013 clinical policy based on 2 critical questions:
Is IV tPA safe and effective for patients with acute ischemic stroke if given within 3 hours of symptom onset?
Is IV tPA safe and effective for patients with acute ischemic stroke treated between 3 to 4.5 hours after symptom onset?