A 70-year-old man with a history of atrial fibrillation on warfarin presents with acute onset right-sided weakness, facial droop, and aphasia. His symptoms started 2 hours ago. Non-contrast head CT shows no evidence of hemorrhage. His INR is 2.5. What is the most appropriate immediate management?

✓ Correct Answer: Option A

Given the acute onset of focal neurological deficits within the thrombolytic window (typically <4.5 hours from symptom onset) and no hemorrhage on CT, intravenous alteplase is the most appropriate immediate treatment for acute ischemic stroke. His INR is therapeutic but not a contraindication to tPA alone.