Table 1 Inclusion and exclusion criteria.

1. Patients presenting with acute ischemic stroke within 4.5 h of stroke onset

2. Age ≥ 18 years and upto 80 years

3. Eligible to receive intravenous (IV) thrombolysis with tissue plasminogen activator tPA and where indicated

4. Endovascular thrombectomy can commence within 6 h of stroke onset and in highly selected cases up to 24 h based on imaging inclusion criteria

1. Any intracranial hemorrhage identified by CT or MRI

2. Pre-stroke mRS score of ≥ 2 (indicating previous disability)

3. Hypodensity in > 1/3 MCA territory on non-contrast CT

4. Presence of carotid dissection

5. Pregnant women

6. Previous stroke within last three months

7. Recent history or clinical presentation of ICH, subarachnoid hemorrhage (SAH), arterio-venous (AV) malformation, aneurysm or cerebral neoplasm (at the discretion of investigator)

8. Current use of oral anticoagulants and a prolonged prothrombin time (INR > 1.7) or use of heparin, except for low dose subcutaneous heparin, in the previous 48 h and a prolonged APTT or use of glycoprotein IIb-IIIa inhibitors within the past 72 h

9. Clinically significant hypoglycemia, uncontrolled hypertension defined by a blood pressure > 185 mmHg systolic or > 110 mmHg diastolic on at least 2 separate occasions at least 10 min apart

10. Hereditary or acquired hemorrhagic diathesis. gastrointestinal or urinary bleeding within the preceding 21 days

11. Major surgery within the preceding 14 days which posed risk

12. Any condition that in the judgment of the investigator could impose hazards to the patient if study therapy is initiated or affect the participation of the patient in the study