Exclusion Criteria

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 days.
• 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).