From the Guidelines
Tissue plasminogen activator (tPA) is contraindicated in patients with absolute contraindications such as significant head trauma, prior stroke in the previous 3 months, symptoms suggesting subarachnoid hemorrhage, and active internal bleeding, among others, as outlined in the guidelines for the early management of patients with acute ischemic stroke 1. The contraindications for tPA are crucial to consider due to the high risk of bleeding complications.
- Absolute contraindications include: + Significant head trauma or prior stroke in previous 3 months + Symptoms suggest subarachnoid hemorrhage + Arterial puncture at noncompressible site in previous 7 days + History of previous intracranial hemorrhage + Intracranial neoplasm, arteriovenous malformation, or aneurysm + Recent intracranial or intraspinal surgery + Elevated blood pressure (systolic >185 mm Hg or diastolic >110 mm Hg) + Active internal bleeding + Acute bleeding diathesis, including but not limited to platelet count <100,000/mm³
- Relative contraindications include: + Only minor or rapidly improving stroke symptoms + Pregnancy + Seizure at onset with postictal residual neurological impairments + Major surgery or serious trauma within previous 14 days + Recent gastrointestinal or urinary tract hemorrhage (within previous 21 days) + Recent acute myocardial infarction (within previous 3 months) These guidelines are based on the American Heart Association/American Stroke Association guidelines for the early management of patients with acute ischemic stroke 1. The decision to administer tPA should be made with careful consideration of the risk to benefit, especially in patients with relative contraindications. In patients without recent use of oral anticoagulants or heparin, treatment with IV tPA can be initiated before availability of coagulation test results but should be discontinued if INR is >1.7 or PT is abnormally elevated by local laboratory standards 1. Similarly, in patients without history of thrombocytopenia, treatment with IV tPA can be initiated before availability of platelet count but should be discontinued if platelet count is <100,000/mm³ 1.
From the FDA Drug Label
Cathflo Activase should not be administered to patients with known hypersensitivity to Alteplase or any component of the formulation The main contraindication of tissue plasminogen activator (TPa) is:
- Known hypersensitivity to Alteplase or any component of the formulation 2
From the Research
Contra Indications of TPa
- The use of tissue plasminogen activator (tPA) has been associated with an increased risk of intracranial hemorrhage, particularly in patients with a history of cerebral hemorrhage 3.
- Studies have shown that the risk of symptomatic intracerebral hemorrhage is higher in patients treated with tPA, especially those with severe neurological deficits and brain edema or mass effect on CT scans 4.
- The combination of tPA and heparin may also increase the risk of hemorrhage, as seen in patients with intracranial hemorrhage after tPA treatment for acute myocardial infarction 5.
- Other potential contraindications for tPA include: + History of cerebral hemorrhage, although this is no longer an absolute contraindication 3 + Severe neurological deficit, as measured by the National Institutes of Health Stroke Scale score 4 + Brain edema or mass effect on CT scans 4 + Use of anticoagulants, such as heparin, in combination with tPA 5
- It is essential to carefully evaluate the risks and benefits of tPA treatment in each patient, taking into account their individual clinical characteristics and medical history 6.
- Recent studies have focused on identifying new methods to predict the risk of rtPA-related intracranial hemorrhage and to develop new measures to limit this risk 7.