What are the contraindications for giving tPA?

Relative Exclusion Criteria Pregnancy. Seizure at the onset with postictal residual neurological impairments. Major surgery or serious trauma within prior 14 days. Recent GI or urinary tract hemorrhage (within previous 21 days)

What is contraindicated in thrombolytic therapy?

Absolute contraindications for thrombolysis include the following: Gastrointestinal (GI) bleeding within the past 6 months. Active or recent internal bleeding. History of hemorrhagic stroke.

Is age contraindication for tPA?

Advanced age is not considered a contraindication or exclusion in the AHA guidelines. Of the patients enrolled in early clinical trials of IV thrombolysis for stroke, only about 0.5% were older than the age of 80 years.

Why thrombolytics are contraindicated in stroke?

Intravenous thrombolysis for stroke is contraindicated if the patient is taking therapeutic doses of LMWH because of the presumed high risk of hemorrhagic complications. Reports of IV thrombolysis given to patients taking LMWH are scarce in the literature.

Is tPA a thrombolytic?

Thrombolytic medicines are approved for the emergency treatment of stroke and heart attack. The most commonly used drug for thrombolytic therapy is tissue plasminogen activator (tPA), but other drugs can do the same thing.

When should you not use alteplase?

When considering alteplase for the treatment of acute ischemic stroke, do not use it in patients with the following conditions:

• Intracranial hemorrhage.
• Subarachnoid hemorrhage.
• Internal bleeding.
• Stroke within the last three months.
• Intracranial or intraspinal surgery within the last three months.

Does alteplase affect blood pressure?

In patients with hypertension >185/110 mm Hg, alteplase is recommend if the blood pressure can be safely lowered and stabilized below 180/105 mm Hg (the post-treatment blood pressure goal.) Single or combination (e.g., aspirin and clopidogrel) antiplatelet therapy is not a contraindication to treatment with alteplase.

Are there any contraindications to TPA for stroke?

Reflects recommendations from Demaerschalk et al, Stroke 2015. 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.

Is there a contraindication for tPA in cardiac catheterization?

Neurology recommended the use of tPA as the patient was within the window period for use. While reviewing the guidelines and contraindications, it was discovered that the patient’s aPTT was higher than the upper normal limit due to the recent use of unfractionated heparin for cardiac catheterization.

When to use intravenous heparin for tPA?

3. Discussion. According to the American Heart Association/American Stroke Association guidelines, the use of IV TPA is relatively contraindicated in patients who have received unfractionated heparin in the past 48 hours with an elevated activated partial thromboplastin time (aPTT).

When to use TPA in the ICU?

Patient was transferred to the ICU and the neurology team was consulted. Neurology recommended the use of tPA as the patient was within the window period for use.