TABLE 2. Absolute and Relative Contraindications to IV tPA Within 3 Hours of Symptom Onset
- Current intracranial hemorrhage
- Subarachnoid hemorrhage
- Active internal bleeding
- Serious head trauma or intracranial or intraspinal surgery within 3 months
- Intracranial conditions that may increase the risk of bleeding (ie, some neoplasms, arteriovenous malformations, or aneurysms)
- Acute bleeding diathesis, including but not limited to:
- Platelet count < 100,000/mm³
- Heparin received within 48 hours, resulting in abnormally elevated aPTT > ULN
- Current use of anticoagulant with INR > 1.7 or PT > 15 seconds
- Severe uncontrolled hypertension (systolic > 185 mm Hg or diastolic > 110 mm Hg)
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- Major surgery or serious trauma within previous 14 days
- Recent intracranial hemorrhage
- Recent gastrointestinal or urinary tract hemorrhage (within previous 21 days)
- Current use of direct thrombin inhibitors or direct factor Xa inhibitors with elevated sensitive laboratory tests (eg, aPTT, INR, platelet count, and ECT; TT; or appropriate factor Xa activity assays)
- Pregnancy
- Recent acute myocardial infarction (within previous 3 months)
- Minor or rapidly improving stroke symptoms
- CT evidence of multilobar infarction (hypodensity > 1/3 cerebral hemisphere)
- Blood glucose concentration < 50 mg/dL
- Arterial puncture at noncompressible site in previous 7 days
- Seizure at onset with postictal residual neurologic impairments
- Any other conditions for which a bleeding event represents a significant hazard and would be especially difficult to manage due to its location
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