NCEMI eTools

TPA for acute stroke - indications/contraindications

tPA for acute stroke

Score: 0 Do NOT thrombolyse - it is contraindicated!
Assessment
15	Thrombolysis is indicated!
13-14	Thrombolysis more risky, but benefits potentially greater
<13	Do NOT thrombolyse - it is contraindicated!

Evidence of intracranial hemorrhage (e.g. on CT scan)?

	Yes -5 points
	No 1 points

Suspicion of subarachnoid hemorrhage?

	Yes -5 points
	No 1 points

Recent intracranial surgery or serious head trauma or recent prior stroke?

	Yes -5 points
	No 1 points

History of intracranial hemorrhage?

	Yes -5 points
	No 1 points

Uncontrolled hypertension at treatment time (over 185 systolic or over 110 diastolic)?

	Yes -5 points
	No 1 points

Seizure at stroke onset?

	Yes -5 points
	No 1 points

Active internal bleeding?

	Yes -5 points
	No 1 points

Intracranial neoplasm, arteriovenous malformation, or aneurysm?

	Yes -5 points
	No 1 points

Known bleeding diathesis?

	Yes -5 points
	No 1 points

Current oral anticoagulant use with PT over 15?

	Yes -5 points
	No 1 points

Use of heparin within last 48 hours and elevated PTT?

	Yes -5 points
	No 1 points

Platelet count under 100,000?

	Yes -5 points
	No 1 points

Stroke symptom onset more than 3 hours ago?

	Yes -5 points
	No 1 points

Severe neurologic deficit (e.g. NIHSS over 22)?

	Yes 0 points
	No 1 points

Major early infarct signs on CT (substantial edema, mass effect, or midline shift)?

	Yes 0 points
	No 1 points