Bleeding tendency Coagulopathy (INR>1.5) Thrombocytopenia (plt< 50000) Previous hypersensitivity to Alteplase Active internal bleeding Severe uncontrolled hypertension Severe renal disease (GFR<50 ml/min) History of recent stroke Hemoptysis at admission Presence of any active malignancy (other than non-melanoma skin cancer) that required treatment within the last 2 years Moderate to severe liver failure (Childs-Pugh Score > 12) Major trauma in the prior 30 days Moribund patient not expected to survive the next 24 hours. No consent/inability to obtain consent

Bleeding tendency Coagulopathy (INR>1.5) Thrombocytopenia (plt< 50000) Previous hypersensitivity to Alteplase Active internal bleeding Severe uncontrolled hypertension Severe renal disease (GFR<50 ml/min) History of recent stroke Hemoptysis at admission Presence of any active malignancy (other than non-melanoma skin cancer) that required treatment within the last 2 years Moderate to severe liver failure (Childs-Pugh Score > 12) Major trauma in the prior 30 days Moribund patient not expected to survive the next 24 hours. No consent/inability to obtain consent