Stroke treatment within 3 hours?

• A. tPA
• B. Heparin
• C. Antiplatelet therapy
• D. Mechanical thrombectomy

Answer: (A)

In acute ischemic stroke, the priority is rapid reperfusion of the brain. Within three hours of onset, intravenous thrombolysis with alteplase (tPA) dissolves the clot and improves functional outcomes when given to eligible patients. It has the strongest evidence for benefit in this early window, and the goal is to restore blood flow as soon as possible while screening for contraindications.

Other options don’t fit this window as the primary acute treatment. Heparin does not improve outcomes in acute stroke and increases the risk of bleeding, so it isn’t used for early reperfusion. Antiplatelet therapy like aspirin is typically started after the acute period or used when thrombolysis isn’t given, but it does not dissolve the clots and isn’t the immediate reperfusion strategy within the first hours. Mechanical thrombectomy is crucial for certain large-vessel occlusions and has its own time windows (often up to 6 hours and beyond in selected cases), but within the first three hours the best single choice for rapid reperfusion is IV tPA.