Which statement about the initial management of acute ischemic stroke is correct?

• A. Antiplatelet therapy should be started within 1 hour
• B. Alteplase within 4.5 hours
• C. Thrombolysis is contraindicated in all stroke within 6 hours
• D. Alteplase within 3 hours

Answer: (B)

In acute ischemic stroke, restoring blood flow as quickly as possible minimizes brain injury, so thrombolysis is used when it can be safely given. Alteplase within 4.5 hours of onset is the best choice because current guidelines allow this treatment window for eligible patients after proper imaging to exclude hemorrhage and other contraindications. This extended window, compared with the earlier 3-hour limit, increases the number of patients who can benefit while still prioritizing safety.

Starting antiplatelet therapy within 1 hour isn’t standard before completing the thrombolysis assessment, and thrombolysis isn’t categorically contraindicated for all strokes within 6 hours—many patients treated within the 4.5-hour window can receive it if they meet safety criteria. The 3-hour window reflects older practice; the 4.5-hour window is the preferred target for eligible patients.