From the Guidelines
The exclusion criteria that would prevent a patient from receiving recombinant tissue plasminogen activator (r-tPA) include a platelet count <100,000/mm³, recent bleeding within the past 21 days, and blood pressure >185 mmHg or >110 mmHg despite treatment, as well as other criteria that increase the risk of bleeding or decrease the potential benefits of thrombolytic therapy. The criteria for exclusion from r-tPA therapy are based on the potential risks and benefits of treatment, with the goal of minimizing the risk of bleeding complications while maximizing the potential benefits of thrombolytic therapy 1. Some of the key exclusion criteria include:
- Platelet count <100,000/mm³, as this increases the risk of bleeding complications 1
- Recent bleeding within the past 21 days, such as gastrointestinal or urinary tract hemorrhage, as this increases the risk of recurrent bleeding 1
- Blood pressure >185 mmHg or >110 mmHg despite treatment, as this increases the risk of hemorrhagic transformation 1
- Recent major surgery, stroke, or serious head trauma within the past 3 months, as this increases the risk of bleeding complications 1
- Current use of anticoagulants with elevated INR >1.7 or PT >15 seconds, as this increases the risk of bleeding complications 1 In the context of the provided options, the correct answers are:
- A: Platelets < 100,000 per microliter of blood
- B: INR > 1.7
- C: GI bleeds in the past 7 days These options are supported by the evidence as exclusion criteria for r-tPA therapy 1.
From the FDA Drug Label
Patients considered at high risk for bleeding or embolization (see PRECAUTIONS, Bleeding)
The exclusion criteria that would prevent a patient from receiving recombinant tissue plasminogen activator (r-tPA) are:
- Bleeding risks: Patients considered at high risk for bleeding or embolization. Specific options that match this criteria are:
- A: Platelets < 100,000 per microliter of blood
- B: INR > 1.7
- C: GI bleeds in the past 7 days
- F: A patient is taking Plavix for peripheral vascular disease 2
From the Research
Exclusion Criteria for Recombinant Tissue Plasminogen Activator (r-tPA)
The following patient information would be exclusion criteria that would prevent a patient from receiving recombinant tissue plasminogen activator (r-tPA):
- Platelets < 100,000 per microliter of blood 3
- INR > 1.7
- GI bleeds in the past 7 days Other options such as a blood pressure of 170/90 mm Hg, a history of colonoscopy with 1 polyp removal (14 days ago), and a patient taking Plavix for peripheral vascular disease may also be considered as exclusion criteria, but there is limited direct evidence from the provided studies to support this 4, 3, 5, 6, 7.