UMEM Educational Pearls

Category: Neurology

Title: tPA Contraindications

Keywords: stroke, tPA, thrombolytics, ICH, hemorrhage, adverse events (PubMed Search)

Posted: 9/28/2017 by Danya Khoujah, MBBS
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Classically, the list of contraindications for tPA in stroke has been extensive and excludes a significant percentage of patients. This scientific statement from AHA clarifies the evidence behind these contraindications, and in short, expands the population of patients that should be considered for tPA.
The following is NOT considered a contraindication for tPA: 
- Age over 80 
- Severe stroke (NIHSS >25)
- Improving symptoms, if patient remains moderately impaired and potentially disabled
- A small (<10 mm) unruptured and unsecured intracranial aneurysm (NOT other vascular malformations)
- Extra-axial intracranial neoplasms (e.g. meningiomas, pituitary adenomas)
- Blood glucose of >400mg/dL that is subsequently normalized
- Seizure at onset of stroke if residual impairment is secondary to stroke not a postictal phenomenon 


Demaerschalk BM, Kleindorfer DO, Adeoye OM, et al; American Heart Association Stroke Council and Council on Epidemiology and Prevention. Scientific Rationale for the Inclusion and Exclusion Criteria for Intravenous Alteplase in Acute Ischemic Stroke: A Statement for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke 47(2):581–641, 2016.