Performance Measurement Network

Question: Reason for extending IV tPA

Patient arrived 1943 with a last known well of 1800. NIHSS = 1 for dysarthria. IV tPA was felt not to be necessary at this time because the patient's only symptom was dysarthria. Upon reevaluation, the patient had recurrence of aphasia and continued dysarthria. It was within the 4.5 hour window, and the patient had no contraindications, so tPA was given at 2218.

The initial decision to not give tPA was because of mild symptoms (NIHSS =1, dysarthria. The patient was given tPA because symptoms worsening within the 4.5 hour window.

Is this an appropriate reason for extending IVtpa?


IV thrombolytic was within 4.5 hours. There is a documented medical reason, i.e., mild sx, NIHSS 1; therefore, select 'Yes' for "Reason for Extending the Initiation of IV Thrombolytic".

Documentation is acceptable to exclude the case. Since criteria for altepalse administration have been updated (Demaerschalk, 2016, mild symptoms as an acceptable reason for delay is subject to question. This case should be reviewed by your team for quality improvement purposes.

Thank you for your inquiry.

Question Details
Focus area(s): Chart Abstracted Measure Specifications – Clinical
Related documents: STK-4, Reason for Extending the Initiation of IV Alteplase,
Manual: Current Manual (current data collection period; prior to data transmission)

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