Table 2.
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