Contraindications for the use of intravenous rTPA for the treatment of acute ischemic stroke can be divided into 3 groups. Clinical contraindications include the following: any history of intracranial hemorrhage; pretreatment systolic blood pressure greater than 185 mm Hg; diastolic blood pressure greater than 110 mm Hg; rapidly improving neurological signs; mild neurologic signs such as isolated sensory deficit; symptoms suggesting subarachnoid hemorrhage, stroke, or serious head trauma within the preceding 3 months; gastrointestinal or urinary hemorrhage within the preceding 21 days; major surgery within the preceding 14 days; arterial puncture at a noncompressible site within the preceding 7 days; recent myocardial infarction; seizure at the onset of the stroke; currently taking oral anticoagulants; and heparin administration within the previous 48 hours. Radiographic contraindications include evidence of intracranial hemorrhage on the computed tomography of the brain. Laboratory contraindications include prothrombin time greater than 15 seconds (international normalized ratio > 1.7), platelet count less than 100 x 103/mm3, elevated partial thromboplastin time, and blood glucose level less than 50 mg/dL.3
- Heparin administration 14 days prior.
3. Tissue plasminogen activator for acute ischemic stroke. The National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group. N Engl J Med 1995;333:15817.
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