Activase® is a standard of care for treating eligible patients with acute ischemic stroke (AIS) within 3 hours of symptom onset 2

The American Heart Association/American Stroke Association (AHA/ASA) practice guidelines recommend Activase for treatment of AIS 2:

Intravenous Activase (0.9 mg/kg, maximum dose 90 mg) is recommended for selected patients who may be treated within 3 hours of ischemic stroke onset (Class 1; Level of Evidence A, 2018 AHA/ASA Guidelines)

Indication for Use 6:

  • Activase is indicated for the treatment of AIS. Exclude intracranial hemorrhage prior to initiation of treatment. Administration should occur as soon as possible but within 3 hours after symptom onset.

If mechanical thrombectomy is considered AHA/ASA guidelines recommend that Activase is administered first 2:

Patients eligible for IV alteplase should receive alteplase even if endovascular treatments are being considered (Class 1; Level of Evidence A, 2018 AHA/ASA Guideline)

The Society of Vascular and Interventional Neurology (SVIN) also recommends endovascular mechanical thrombectomy, in addition to treatment with IV alteplase in eligible patients, for anterior circulation large vessel occlusion ischemic strokes in patients presenting within 6 hours after symptom onset (Class 1; Level of Evidence A, 2015 SVIN Recommendations) 9

Indication for Use:

  • The mechanical thrombectomy device is indicated for use to restore blood flow in the neurovasculature by removing thrombus for the treatment of AIS to reduce disability in patients with a persistent, proximal anterior circulation, LVO, and smaller infarcts who have first received IV alteplase. Endovascular therapy with the device should start within 6 hours of symptom onset* 10,11

Evaluate Activase treatment procedures and protocols to ensure all changes and guidelines are incorporated

Various resources are used in making treatment decisions. Clinical judgment and the hospital protocol review process should guide clinical decisions. 

Prescribing Information Revisions

  • February 2015 – the Activase Prescribing Information (PI) was revised to reflect the Physician Labeling Rule (PLR). 6 The PLR reinforces clear section definitions for the appropriate categorization of prescribing information. Therefore, information in the Activase PI has changed
  • January 2017/March 2018 – the Activase PI was revised with updated Important Safety Information

FDA Recommendation

  • October 2015 – the FDA issued a recommendation to use full drug names instead of the abbreviation “tPA” 4
  • The recommendation was issued to address reported medication errors and advises healthcare professionals prescribing Activase to use either the brand name or the generic name in written prescriptions and verbal orders 12

AHA/ASA Recommendations

  • March 2018 – the AHA/ASA released new AIS treatment guidelines including updated recommendations for Activase use 2

*Please refer to the instructions for use for the Trevo® XP ProVue Retriever and the Solitaire™ Platinum Revascularization Device for more information.

NEXT: Learn how to identify appropriate patients for Activase treatment


  • With over 530,000 patients treated since its approval in 1996, Activase is the only medication proven to affect outcomes when administered within the recommended time frame after ischemic stroke. 3,13
  • The FDA stated that “tPA” is the abbreviation for the drug class that encompasses all tissue plasminogen activators. To avoid confusion and medication errors, it has directed healthcare professionals to use either the brand name, Activase, or the generic name, alteplase, in written prescriptions and verbal orders. 12