Table 2.

Contraindications for intravenous recombinant tissue plasminogen activator (rtPA) in acute ischemic stroke

Contraindications applicable to use of intravenous rtPA in acute ischemic stroke (AIS)

Onset of stroke symptoms more than 4.5 h.Ψ

History of stroke or significant head trauma in previous 3 months

Previous intracranial haemorrhage.

Symptoms are suggestive of subarachnoid haemorrhage.

Prolonged blood pressure elevation (systolic ≥185 mmHg or diastolic ≥110 mmHg).

Hypoglycemia (serum glucose <50 mg/dL (<2.8 mmol/L)).

Active internal bleeding, acute bleeding diathesis, including platelet count <100, 000/mm3, current anticoagulant use with an INR > 1.7, or PT > 15 s.

Heparin use within 48 h with an abnormally elevated aPTT.

Arterial puncture at noncompressible site in previous 7 days.

History of gastrointestinal tract haemorrhage within 21 days.

The recent history of major surgery intracranial or intraspinal surgery within 14 days.

Previous history of a previous aneurysm, arteriovenous malformation, or intracranial neoplasm.

Current use of a direct thrombin inhibitor or direct factor Xa inhibitors with an evidence of anticoagulation effect by laboratory tests such as aPTT, INR < ECT, TT, or relevant factor Xa activity assays.

Early ischemic changes are visible on CT in more than one-third of MCA artery vascular territory consistent with irreversible injury or evidence of haemorrhage on CT scan.

^ΨAdditional criteria applicable for IV-rtPA between 3 to 4.5 h: patient older than 80 years, severe stroke (baseline NIHSS >25), no prior history of diabetes mellitus and AIS (both), and not currently on any oral anticoagulants regardless of INR.

CT Computed tomography; INR International normalised ratio; IV-rtPA Intravenous recombinant tissue plasminogen activator; MCA Middle cerebral artery; NIHSS National Institute of Health Stroke Scale; PT Prothrombin time; aPTT Activated partial thromboplastin time; ECT Ecarin clotting time