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Review
. 2015 Jul;5(3):110-21.
doi: 10.1177/1941874415578532.

Absolute and Relative Contraindications to IV rt-PA for Acute Ischemic Stroke

Jennifer E Fugate  1 , Alejandro A Rabinstein  1
Affiliations
Review

Absolute and Relative Contraindications to IV rt-PA for Acute Ischemic Stroke

Jennifer E Fugate et al. Neurohospitalist. 2015 Jul.

Abstract

Most of the contraindications to the administration of intravenous (IV) recombinant tissue plasminogen activator (rtPA) originated as exclusion criteria in major stroke trials. These were derived from expert consensus for the National Institute of Neurological Disorders and Stroke (NINDS) trial. Despite the fact that the safety and efficacy of IV rtPA has been repeatedly confirmed in large international observational studies over the past 20 years, most patients with acute ischemic stroke disappointingly still do not receive thrombolytic treatment. Some of the original exclusion criteria have proven to be unnecessarily restrictive in real-world clinical practice. It has been suggested that application of relaxed exclusion criteria might increase the IV thrombolysis rate up to 20% with comparable outcomes to thrombolysis with more conventional criteria. We review the absolute and relative contraindications to IV rtPA for acute ischemic stroke, discussing the underlying rationale and evidence supporting these exclusion criteria.

Keywords: acute stroke; contraindications; thrombolytic therapy; tissue plasminogen activator.

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Conflict of interest statement

Declaration of Conflicting Interests: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

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