When should you not use TPA?

Contraindications for IV tPA:

1. □ Symptom onset is unknown, > 4.5 hours, or if patient awoke with stroke.
2. □ Acute or previous intracranial hemorrhage.
3. □ Imaging showing extensive regions of irreversible injury (hypoattenuation)
4. □ Prior ischemic stroke, severe head trauma, or intracranial/intraspinal surgery within 3 months.

Why would you not give TPA?

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.

What happens if TPA is given too slow?

Bolus to infusion delays or interruptions in the infusion of TPA after the bolus may significantly impact serum TPA levels and may reduce the efficacy of thrombolysis. Protocols or administration regimens should be employed to prevent delays or interruptions in the infusion.

Are there any absolute contraindications to taking TPA?

Because of the risk of hemorrhage is thought to outweigh any potential benefits, patients with any absolute contraindication should not be given tPA.

Are there any TPA contraindications for acute ischemic stroke?

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

Are there any contraindications to tissue plasminogen activator?

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 have a CT scan with TPA?

Patients presenting with a potential acute ischemic stroke should have a non-contrast CT scan of the head performed as soon as is safely possible. If the patient is a candidate for thrombolysis with tPA they should be carefully evaluated for any absolute or relative contraindications.