Intravenous alteplase improves outcome in selected patients with acute ischemic stroke when given within 4.5 hours from onset.1,2 Despite its efficacy, the use of alteplase is limited by the risk of hemorrhagic complications, particularly symptomatic intracranial hemorrhage (sICH). The risk of sICH varies on the basis of patient population and the definition of sICH used but generally ranges from 2% to 7%.3 Treatment of alteplase-associated sICH is based on expert opinion and small case series, and the efficacy of such treatments is not well established. In this scientific statement, we aim to provide an overview of sICH with a focus on pathophysiology and treatment.
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