- Recent intracranial hemorrhage (ICH)
- Structural cerebral vascular lesion.
- Intracranial neoplasm.
- Ischemic stroke within three months.
- Possible aortic dissection.
- Active bleeding or bleeding diathesis (excluding menses)
When should thrombolytic therapy not be used?
Generally, thrombolytics may not be given if you have: A
recent head injury
.
Bleeding problems
.
Bleeding ulcers
.
What are contraindications to the administration of a thrombolytic in the event of a stroke?
Intravenous thrombolysis for stroke is contraindicated
if the patient is taking therapeutic doses of LMWH because
of the presumed high risk of hemorrhagic complications. Reports of IV thrombolysis given to patients taking LMWH are scarce in the literature.
What are the contraindications for thrombolytics like tPA alteplase )?
- Significant head trauma or prior stroke in the previous 3 months.
- Symptoms suggest subarachnoid hemorrhage.
- Arterial puncture at a noncompressible site in previous 7 days.
- History of previous intracranial hemorrhage.
- Intracranial neoplasm, AVM, or an aneurysm.
- Recent intracranial or intraspinal surgery.
What is an absolute contraindication to fibrinolytic thrombolytic therapy?
Active bleeding or bleeding diathesis
(excluding menses) Significant closed head trauma or facial trauma within 3 months. Intracranial or intraspinal surgery within 2 months. Severe uncontrolled hypertension (unresponsive to emergency therapy)
What is the golden hour for stroke patients?
A door-to-treatment time
of 60 minutes or less
is the goal. This 60-minute period is often referred to as the “golden hour” of acute ischemic stroke treatment during which a focused diagnostic workup must be completed to rule out conditions that may mimic stroke as well as contraindications to rt-PA administration.
What drug dissolves clots?
Anticoagulants
. Anticoagulants, such as heparin, warfarin, dabigatran, apixaban, and rivaroxaban, are medications that thin the blood and help to dissolve blood clots.
What are the indications for thrombolytic therapy in a stroke?
- Diagnosis of ischemic stroke causing measurable neurologic deficit.
- Neurologic signs not clearing spontaneously.
- Neurologic signs not minor and isolated.
- Symptoms not suggestive of subarachnoid hemorrhage.
- Onset of symptoms less than 3 hours hours before beginning treatment.
What is the longest recommended time after a stroke that thrombolytics can be given?
For most people thrombolysis needs to be given within
four and a half hours
of your stroke symptoms starting. In some circumstances, your doctor may decide that it could still be of benefit within six hours. However, the more time that passes, the less effective thrombolysis will be.
What are the contraindications for alteplase?
Due to an increased risk for bleeding, alteplase is contraindicated in patients being treated for
acute myocardial infarction or pulmonary embolism
with the following concomitant conditions: severe uncontrolled hypertension, aneurysm or arteriovenous malformation; known coagulopathy or bleeding diathesis; active …
Who is not a candidate for thrombolytic therapy?
Myocardial infarction within
the previous three months may also exclude a patient from fibrinolytic therapy. Additional relative contraindications include major trauma or surgery within the previous two weeks or recent gastrointestinal hemorrhage. This is due to the increased risk of bleeding.
Who should not get 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.
Is aspirin a contraindication for tPA?
However, it should be noted that pre-TPA aspirin use was not associated with an increased ICH risk in patients given the drug (16) and therefore pre-morbid aspirin use
is not considered a contraindication for TPA administration
in acute stroke.
What are the contraindications for beginning fibrinolytic therapy?
- Prior intracranial hemorrhage.
- Ischemic stroke within 3 months.
- Known cerebrovascular abnormality such as aneurysm or arteriovenous malformation.
- Known malignant intracranial tumor.
- Significant closed-head trauma or facial trauma within 3 months.
What drugs are used in thrombolytic therapy?
- Eminase (anistreplase)
- Retavase (reteplase)
- Streptase (streptokinase, kabikinase)
- t-PA (class of drugs that includes Activase)
- TNKase (tenecteplase)
- Abbokinase, Kinlytic (rokinase)
What is the most common complication of fibrinolytic therapy?
The most feared complication of fibrinolysis is
intracranial hemorrhage (ICH)
, but serious hemorrhagic complications can occur from bleeding at any site in the body. Risk factors for hemorrhagic complications include the following: Increasing age. Lower body weight.
