Page 47 - Radiology Book

no
tPa contraindications
Evidence of intracranial hemorrhage on pretreatment noncontrast head CT?
Clinical presentation suggestive of subarachnoid hemorrhage even with normal CT?
CT shows multilobar infarction (hypodensity greater than one third of the cerebral hemisphere)?
Blood glucose <50 mg/dL?
Uncontrolled Hypertension
At the time treatment should begin, systolic pressure remains >185 mmHg or diastolic pressure remains >110 mmHg despite repeated measurements?
Known arteriovenous malformation, neoplasm, aneurysm or history of intracranial hemorrhage?
Active internal bleeding or acute trauma (fracture)?
Acute bleeding diathesis including but not limited to:
· Platelet count <100,000/mm3
· Heparin received within 48 hours that resulted in an activated partial thromboplastin time (aPTT) greater than the upper normal limit?
· Current use of an anticoagulant (eg, warfarin) that has produced an elevated international normalized ratio (INR) >1.7 or prothrombin time (PT) >15 seconds?*
· Stroke signs seen within 3 months of intracranial or intraspinal surgery, serious head trauma, or previous stroke?
· Current use of direct thrombin inhibitors or direct factor Xa inhibitor with elevated tests (PTT, INR, PLT, ECT, TT, Xa activity)
· Arterial puncture at a noncompressible site within the past 7 days?
** 3-4.5 hour Exclusion Criteria
· Age greater than 80 years
· Severe stroke (NIHSS >25)
· Taking an oral anticoagulant regardless of INR
· History of both diabetes and prior ischemic stroke
stroke fibrinolytic cHecklist
Exclusion Criteria for 180 min or 3 hours (3-4.5 hrs**) All No boxes must be checked prior to TPA administration.
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NOTE: *In patients without recent use of oral anticoagulants or heparin, treatment with TPA can be initiated before coagulation study results are received, but should be discontinued if the INR is >1.7 or the PTT is elevated by local laboratory standards.
Stroke