Central nervous system
Juvenile myoclonic epilepsy
Low molecular-weight heparin
Loss of consciousness
Monoamine oxidase inhibitor
Nonsteroidal anti-inflammatory drug
Patent foramen ovale
Alteplase (tissue plasminogen activator)
Table 4.1.1 Criteria for t-PA Use in Acute Ischemic Stroke |Favorite Table|Download (.pdf)
Table 4.1.1 Criteria for t-PA Use in Acute Ischemic Stroke
All of the items below must be true in order to use t-PA:
- Age 18 years or older
- Clinical diagnosis of ischemic stroke causing a measurable neurologic deficit
- Time of symptom onset well established to be less than 4.5 hours before treatment would begin
All of the items below must be false in order to use t-PA:
- Evidence of intracranial hemorrhage on noncontrast head CT
- Only minor or rapidly improving stroke symptoms
- High clinical suspicion of subarachnoid hemorrhage even with normal CT
- Active internal bleeding (e.g., GI/GU bleeding within 21 days)
- Known bleeding diathesis, including but not limited to platelet count <100,000/mm3
- Patient has received heparin within 48 hours and had an elevated APTT
- Recent use of anticoagulant (e.g., warfarin) and elevated PT (>15 second)/INR
- Intracranial surgery, serious head trauma, or previous stroke within 3 months
- Major surgery or serious trauma within 14 days
- Recent arterial puncture at noncompressible site
- Lumbar puncture within 7 days
- History of intracranial hemorrhage, arteriovenous malformation, or aneurysm
- Witnessed seizure at stroke onset
- Recent acute myocardial infarction
- SBP >185 mm Hg or DBP >110 mm Hg at time of treatment
Additional exclusion criteria if within 3–4.5 hours of onset:
- Age greater than 80 years
- Current treatment with oral anticoagulants
- NIH Stroke Scale Score >25 (severe stroke)
- History of both stroke and diabetes
Figure 4.1.2 Pharmacotherapy of Acute Ischemic Strokea
Sources: (1) Furie KL, Kasner SE, Adams RJ, et al.; on behalf of the American Heart Association Stroke Council, Council on Cardiovascular Nursing, Council on Clinical Cardiology, and Interdisciplinary Council on Quality of Care and Outcomes Research. Guidelines for the prevention of stroke in patients with stroke or transient ischemic attack: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2011;42:227–276. (2) Lansberg MG, O'Donnell MJ, Khatri P, et al. Antithrombotic ...
Log In to View More
If you don't have a subscription, please view our individual subscription options below to find out how you can gain access to this content.
Want remote access to your institution's subscription?
Sign in to your MyAccess profile while you are actively authenticated on this site via your institution (you will be able to verify this by looking at the top right corner of the screen - if you see your institution's name, you are authenticated). Once logged in to your MyAccess profile, you will be able to access your institution's subscription for 90 days from any location. You must be logged in while authenticated at least once every 90 days to maintain this remote access.
If your institution subscribes to this resource, and you don't have a MyAccess profile, please contact your library's reference desk for information on how to gain access to this resource from off-campus.
AccessPharmacy Full Site: One-Year Subscription
Connect to the full suite of AccessPharmacy content and resources including 30+ textbooks such as Pharmacotherapy: A Pathophysiologic Approach and Goodman & Gilman's The Pharmacological Basis of Therapeutics, high-quality videos, images, and animations, interactive board review, drug and herb/supplements databases, and more.
Pay Per View: Timed Access to all of AccessPharmacy
24 Hour Subscription $34.95
48 Hour Subscription $54.95
Pop-up div Successfully Displayed
This div only appears when the trigger link is hovered over.
Otherwise it is hidden from view.