No tpa if any of the following

= Recent use of noac
= Coagulopathy (plateletss < 100k, inr > 1.7, aPTT> 40, or PT >15)
= Infective endocarditis
= Intra cranial, spine surgery < 3 months
= Recent GI/GU bleed within 3 weeks
= Extensive and clear hypoattenuation on CT
= Suspicion for Subarachnoid Hemorrhage
= Suspicion for aortic dissection
= Hx of sickle cell disease

OK to gvie TPA
= severe symptoms (Benefit outweigh risks, do have higher risk for bleed, needs to explain to family)
= mild but disabling symptom
= stroke with acute MI
= small or moderate unruptured cerebral aneurysm