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Contraindications to IV Thrombolysis for Ischemic Stroke
Contraindications to IV Thrombolysis for Ischemic Stroke
Current intracranial haemorrhage or prior ICH
Ischaemic stroke or serious head trauma in prior 3 months
Intracranial or intraspinal surgery in prior 3 months
Intracranial neoplasm, AVM, or aneurysm
Active internal bleeding or GI malignancy/haemorrhage risk
Platelets <100k, INR >1.7, elevated aPTT, or DOAC within 48 h
Blood pressure >185/110 mmHg despite treatment
Blood glucose <50 mg/dL (2.7 mmol/L) and deficit resolves with correction
CT with extensive hypodensity (>1/3 MCA territory)
ResultNo absolute contraindication
No absolute contraindication identified; assess time window, deficit severity, and relative cautions.
- Absolute contraindications
- 0
When to use
- Rapid eligibility screen before IV thrombolysis in acute ischaemic stroke.
Formula
Any single absolute contraindication present -> thrombolysis contraindicated.
Pearls and pitfalls
- Reflects AHA/ASA absolute contraindications; relative cautions still require individual judgement.
- Does not replace confirming symptom-onset time window.