Do NOT administer tPA if any of these statements are true:
- symptoms are minor or rapidly improving.
- seizure at onset of stroke.
- another stroke or serious head trauma within the past 3 months.
- major surgery within the last 14 days.
- known history of intracranial hemorrhage.
- sustained systolic blood pressure >185 mmHg.
- sustained diastolic blood pressure >110 mmHg.
- aggressive treatment is necessary to lower the blood pressure.
- symptoms suggestive of subarachnoid hemorrhage.
- gastrointestinal or urinary tract hemorrhage within the last 21 days.
- arterial puncture at noncompressible site within the last 7
- received heparin with the last 48 hours and elevated PTT.
- prothrombin time (PT) is >15 seconds.
- platelet count is <100,000 uL.
- serum glucose is <50 mg/dL or >400 mg/dL.
tPA Relative Contraindications
If any of the following is true, use tPA with caution:
- Patient has a large stroke with NIH Stroke Scale score >22.
- Patient's CT shows evidence of large middle cerebral artery (MCA) territory
infarction (sulcal effacement or blurring of gray-white junction in greater than
1/3 of MCA territory).