In the Clinical Practice article by van der Worp and van Gijn (Aug. 9 issue),1 the question of the age at which a patient could be selected for treatment with intravenous thrombolysis warrants further attention. According to the Safe Implementation of Thrombolysis in Stroke Monitoring Study (SITS-MOST) selection criteria,2 this treatment cannot be delivered to patients older than 80 years of age in routine clinical practice, but it has been shown that early treatment with recombinant tissue plasminogen activator (rt-PA) in carefully selected elderly patients is as safe and efficacious as it is in younger patients.3 A specific randomized trial is highly advisable before implementation of this therapy in routine clinical practice. The authors discuss the use of alteplase, but they do not discuss other fibrinolytic drugs (such as tenecteplase and desmoteplase) as being potential alternatives to this agent.