Stroke fibrinolysis checklist

AHA Stroke Fibrinolytic checklist

Exclusion Criteria (NONE must apply)

• Evidence of intracranial haemorrhage on pretreatment noncontrast head CT?
• Clinical presentation suggestive of subarachnoid haemorrhage even with normal CT?
• CT shows multilobar infarction (hypodensity greater than one third cerebral hemisphere)?
• History of intracranial haemorrhage?
• Uncontrolled hypertension: SBP > 185 mm Hg or DBP>110 mm Hg despite repeated measurements?
• Known arteriovenous malformation, neoplasm, or aneurysm?
• Witnessed seizure at stroke onset?
• Active internal bleeding or acute trauma (fracture)?
• Acute bleeding diathesis, including:
  • Platelet count <100 000/mm3? 
  • Heparin received within 48 hours
  • Current use of anticoagulant with INR >1.7 or prothrombin time PT >15 seconds?*
• Within 3 months of intracranial or intraspinal surgery, serious head trauma, or previous stroke?
• Arterial puncture at a noncompressible site within past 7 days?
• Only minor or rapidly improving stroke symptoms (clearing spontaneously)
• Within 14 days of major surgery or serious trauma
• Recent gastrointestinal or urinary tract haemorrhage (within previous 21 days)
• Recent acute myocardial infarction (within previous 3 months)
• Post myocardial infarction pericarditis
• Abnormal blood glucose level (<50 or >400 mg/dL [<2.8 or >22.2 mmol/L])*
• In patients without recent use of oral anticoagulants or heparin, treatment with tPA can be initiated before availability of coagulation study results but should be discontinued if the INR is >1.7 or the partial thromboplastin time is elevated by local