neurology emergency

tPA Contraindications for Ischemic Stroke

Checklist of absolute and relative contraindications to IV alteplase (tPA) for acute ischaemic stroke. Any absolute contraindication = tPA not indicated.

Within treatment time window (≤3.0h standard; 3.0–4.5h if meeting extended criteria)*

Significant head trauma or prior stroke within 3 months*

Intracranial/intraspinal surgery within 3 months*

History of intracranial haemorrhage*

Uncontrolled hypertension: BP >185/110 mmHg despite treatment*

Symptoms minor and isolated OR rapidly improving*

Coagulopathy (platelet <100k, INR >1.7, aPTT >40, anticoagulants with therapeutic anticoagulation)*

Blood glucose <2.7 mmol/L (<50 mg/dL) or >22.2 mmol/L (>400 mg/dL)*

Major surgery or serious trauma within 14 days*

References

Powers WJ et al. Guidelines for the Early Management of Patients With Acute Ischemic Stroke: 2019 Update. Stroke. 2019;50(12):e344–e418.

Curated clinical cross-links plus same-class fallbacks.

Calculators

Drugs

Pathways

Decision support only — verify against MDCalc, NICE, or your local guideline before clinical use.

References

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