Page 48 - Radiology Book

relative tPa contraindications/ Precautions
Recent experience suggests that under some circumstances with careful consideration and weighing of risk-to-bene t ratio-patients may receive brinolytic therapy despite one or more relative contraindications listed below:
· Only minor/rapidly improving stroke symptoms (clearing spontaneously).
· Pregnancy.
· Within 14 days of major surgery or serious trauma.
· Gastrointestinal/urinary tract hemorrhage within the
previous 21 days.
· Recent acute myocardial infarction
(within previous 3 months).
· Seizure at the onset with postictal neurological
impairments.
HyPercoagulable workuP in stroke
Acute Inpatient Setting
· CBC with diff, PLTs, PT/PTT/INR
· Activated protein C resistance/Factor V Leiden gene mutation · Prothrombin G20210A mutation
· Antiphospholipid antibodies (ethanolamine, serine, choline) · Anticardiolipin Ab (immunoglobulins G and M)
· Lupus anticoagulation: dRVVT (affected by heparin)
· Anti-β-2 glycoprotein
Outpatient Follow-up
6 weeks after thrombosis
· Protein C level (decreased by Coumadin)
· Protein S level (decreased by Coumadin)
· Antithrombin level (decreased by heparin)
· Homocysteine (if elevated, test folate, B12, creatinine,
MTHFR mutation)
· Fibrinogen level · Lipoprotein A level · Factor VIII level
· Hemoglobin electrophoresis (patients with AA)/SPEP Additional Tests
Order if negative above and high clinical suspicion
· Plasminogen antigen and activity
· Workup for chronic DIC · Platelet aggregation tests · Clotting factors · Refer to hematology
Southfield16
Stroke