tPA Contraindications for Ischemic Stroke

Checklist-based screen for alteplase eligibility, absolute contraindications, relative warnings, and extended-window exclusions in acute ischemic stroke

Age ≥18 years*

Clinical diagnosis of ischemic stroke causing measurable neurological deficit*

Treatment time window*

≤3 hours from symptom onsetlte_3h

>3 to 4.5 hours from symptom onset3_to_45h

>4.5 hours from symptom onsetgt_45h

Intracranial hemorrhage on CT*

Clinical presentation suggests subarachnoid hemorrhage*

Significant head trauma or prior stroke in previous 3 months*

Arterial puncture at a 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 mmHg or diastolic >110 mmHg)*

Active internal bleeding*

Acute bleeding diathesis*

Blood glucose <50 mg/dL*

CT demonstrates multilobar infarction (hypodensity >1/3 cerebral hemisphere)*

Only minor or rapidly improving stroke symptoms*

Pregnancy*

Seizure at onset with residual neurological impairment*

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)*

Age >80 years*

History of both prior stroke and diabetes*

Oral anticoagulant use regardless of INR (3–4.5 hour additional exclusion)*

NIHSS >25*