tPA Inclusion and Exclusion Criteria

Source:http://www.acep.org/content.aspx?id=29936
tPA Inclusion and Exclusion Criteria

tPA Indications
These statements must be true in order to consider tPA administration:
Ischemic stroke onset within 3 hours of drug administration.
Measurable deficit on NIH Stroke Scale examination.
Patient's computed tomography (CT) does not show hemorrhage or nonstroke cause of deficit.
Patient's age is >18 years.

tPA Contraindications
Do NOT administer tPA if any of these statements are true:
Patient's symptoms are minor or rapidly improving.
Patient had seizure at onset of stroke.
Patient has had another stroke or serious head trauma within the past 3 months.
Patient had major surgery within the last 14 days.
Patient has known history of intracranial hemorrhage.
Patient has sustained systolic blood pressure >185 mmHg.
Patient has sustained diastolic blood pressure >110 mmHg.
Aggressive treatment is necessary to lower the patient's blood pressure.
Patient has symptoms suggestive of subarachnoid hemorrhage.
Patient has had gastrointestinal or urinary tract hemorrhage within the last 21 days.
Patient has had arterial puncture at noncompressible site within the last 7 days.
Patient has received heparin with the last 48 hours and has elevated PTT.
Patient's prothrombin time (PT) is >15 seconds.
Patient's platelet count is <100,000 uL.
Patient's serum glucose is <50 mg/dL or >400 mg/dL.

tPA Relative Contraindications
If either of the following statements 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).