If an aphasic patient presenting for ischemic stroke has a confirmed LKW <4.5 hours but you are unable to confirm other absolute contraindications (medications, recent surgeries, GI bleeding, etc.) to tenecteplase, what is your approach to determining thrombolysis eligibility?

I take a case-by-case approach to this type of situation. In practice, you can’t always rule out every major contraindication with 100% confidence within the timeframe required to give a thrombolytic. For example, a patient may not know they have severe thrombocytopenia, but I won’t go looking if th...