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Kushal Bhatia: Is The 4.5-Hour Thrombolysis Window Officially Outdated?
Kushal Bhatia/LinkedIn
Apr 11, 2026, 13:37

Kushal Bhatia: Is The 4.5-Hour Thrombolysis Window Officially Outdated?

Kushal Bhatia, Consultant Neurosurgeon and Interventional Neurologist at Gleneagles Hospitals, shared on LinkedIn:

”Is the 4.5-hour thrombolysis window officially outdated?

A new JAMA RCT (OPTION trial) challenges our long-held boundaries.

In patients with non–large vessel stroke plus salvageable brain tissue, IV tenecteplase given up to 24 hours:

  • Improved excellent outcomes (mRS 0–1)
  • But increased symptomatic ICH

43.6% vs 34.2% — a meaningful shift.

The bigger message?

We are moving from a ‘time window’ to ’tissue window’ paradigm

For centers without thrombectomy access, this could be practice-changing.

Careful patient selection remains EVERYTHING.”

Kushal Bhatia: Is The 4.5-Hour Thrombolysis Window Officially Outdated?

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