Table 2.

Indications and contraindications for intravenous rt-PA in acute ischemic stroke.

Indications
Diagnosis of ischemic stroke causing a measurable neurological deficit
Onset of symptoms <4.5 h before initiation of treatment
CONTRAINDICATIONS
Clinical
Sustained hypertension above 180/110 mm Hg
Symptoms suggestive of subarachnoid hemorrhage
Previous history of intracranial hemorrhage
ST elevation myocardial infarction within the previous 3 months
Major head trauma or stroke within the previous 3 months
Major surgery within the previous 14 days
Gastrointestinal or urinary tract hemorrhage within the previous 21 days
Arterial puncture at a non-compressible site within the previous 7 days
Active bleeding or acute traumatic fracture on examination
Seizure at onset with suspected postictal deficits
Minor or rapidly improving neurological deficits
Radiological
Head CT showing hemorrhage or multilobar infarction (i.e., hypodensity involving >1/3 of the cerebral hemisphere
Laboratory
oral anticoagulation with INR >1.7*
Heparin within previous 48 h with elevated current aPTT
Platelet count <100,000 per mm3
Blood glucose level <50 mg/dL (2.7 mmol/L) at presentation with improving deficits following correction of hypoglycemia
Additional contraindications for treatment between 3 and 4.5 h
Age >80 years
Very severe deficits at onset (NIHSS score >25)
Combination of previous stroke and diabetes mellitus

*Oral anticoagulation regardless of current INR should be considered a contraindication for treatment between 3 and 4.5 h.