This is an unprecedented time. It is the dedication of healthcare workers that will lead us through this crisis. Thank you for everything you do.

      Calc Function

    • Calcs that help predict probability of a diseaseDiagnosis
    • Subcategory of 'Diagnosis' designed to be very sensitiveRule Out
    • Disease is diagnosed: prognosticate to guide treatmentPrognosis
    • Numerical inputs and outputsFormula
    • Med treatment and moreTreatment
    • Suggested protocolsAlgorithm

    Disease

    Select...

    Specialty

    Select...

    Chief Complaint

    Select...

    Organ System

    Select...

    Patent Pending

    tPA Contraindications for Ischemic Stroke

    Provides inclusion/exclusion criteria when deciding to use tPA on a patient with acute ischemic stroke.

    INSTRUCTIONS

    Institutions may have slightly different absolute and relative contraindications to Tissue Plasminogen Activator (tPA); this list is meant to be a quick reference, but practice should be guided by institutional protocol and consultation with neurology. Reflects recommendations from Demaerschalk et al, Stroke 2015.

    When to Use
    Pearls/Pitfalls
    Why Use

    The list of absolute and relative contraindications to tPA should be reviewed in any patient with an acute ischemic stroke in whom thrombolysis is being considered.

    There are strict protocols concerning the appropriate administration of tPA in patients with ischemic stroke, including a list of absolute and relative contraindications.

    • Because of the risk of hemorrhage is thought to outweigh any potential benefits, patients with any absolute contraindication should not be given tPA.
    • For patients within the 3-hour window who meet the inclusion criteria and have no contraindications, earlier administration of tPA was associated with improved outcomes in one randomized trial (NINDS II).

    Points to keep in mind:

    • tPA for patients with acute ischemic stroke is associated with a significant increase in symptomatic intracranial hemorrhage, so it is essential to adhere to accepted protocols and to engage in shared decision making with the patient or their family when considering administering tPA.
    • The evidence and strength of recommendations for giving tPA in the 3-4.5 hour window is less robust than for giving thrombolytics inside the 180 minutes from onset of symptoms.

    The principal risk of tPA is symptomatic or fatal hemorrhage. It is essential that patients be evaluated for any history or risk factors that would put them at an increased risk of a hemorrhagic outcome.

    Eligibility for tPA
    No
    Yes
    No
    Yes
    No
    Yes
    Absolute Contraindications to tPA
    No
    Yes
    No
    Yes
    No
    Yes
    No
    Yes
    No
    Yes
    No
    Yes
    No
    Yes
    No
    Yes
    No
    Yes
    No
    Yes
    Relative Contraindications/Warnings to tPA
    No
    Yes
    No
    Yes
    No
    Yes
    No
    Yes
    No
    Yes
    No
    Yes
    No
    Yes
    No
    Yes
    Additional Warnings to tPA >3hr Onset
    No
    Yes
    No
    Yes
    No
    Yes
    No
    Yes
    No
    Yes

    Result:

    Please fill out required fields.

    Next Steps
    Evidence
    Creator Insights
    Dr. Edward C. Jauch

    About the Creator

    Edward C. Jauch, MD, MS, is a professor and director of emergency medicine at the Medical University of South Carolina. He was chair of Stroke Council for the American Heart Association/American Stroke Association and primary author for the new Acute Ischemic Stroke guidelines. Dr. Jauch conducts research in acute ischemic stroke care, biomarker development in cerebrovascular injuries and other neurologic emergencies.

    To view Dr. Edward C. Jauch's publications, visit PubMed

    Are you Dr. Edward C. Jauch? Send us a message to review your photo and bio, and find out how to submit Creator Insights!
    MDCalc loves calculator creators – researchers who, through intelligent and often complex methods, discover tools that describe scientific facts that can then be applied in practice. These are real scientific discoveries about the nature of the human body, which can be invaluable to physicians taking care of patients.
    Content Contributors
    About the Creator
    Dr. Edward C. Jauch
    Are you Dr. Edward C. Jauch?
    Content Contributors