Thrombolytics for acute ischemic stroke - Revision history

Danbot: Add peer-reviewed reference

2026-03-22T10:09:09Z

Add peer-reviewed reference

← Older revision		Revision as of 10:09, 22 March 2026
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	==Studies Required==		==Studies Required==
	*Physical exam: [[NIH Stroke Scale]]		*Physical exam: [[NIH Stroke Scale]]<ref>Powers WJ, et al. Guidelines for the Early Management of Patients With Acute Ischemic Stroke: 2019 Update. Stroke. 2019;50(12):e344-e418. PMID 31662037</ref>
	*[[Head CT]]		*[[Head CT]]
	*CBC (hemoglobin, plt)		*CBC (hemoglobin, plt)

ClaireLewis at 22:44, 1 October 2019

2019-10-01T22:44:33Z

← Older revision		Revision as of 22:44, 1 October 2019
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	==Studies Required==		==Studies Required==
	*Physical exam: [[NIH Stroke Scale]]		*Physical exam: [[NIH Stroke Scale]]
	*Head CT		*[[Head CT]]
	*CBC (hemoglobin, plt)		*CBC (hemoglobin, plt)
	*PT/PTT/INR		*PT/PTT/INR
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	===Exclusion Criteria===		===Exclusion Criteria===
	*Historical		*Historical
	**Stroke or head trauma in previous 3 months		**[[Stroke]] or [[head trauma]] in previous 3 months
	**Any history of intracranial hemorrhage		**Any history of [[intracranial hemorrhage]]
	**Major surgery in the previous 14 days		**Major surgery in the previous 14 days
	**GI or urinary tract bleeding in previous 21 days		**[[GI bleed\|GI]] or [[hematuria\|urinary tract]] bleeding in previous 21 days
	**[[Myocardial infarction]] in previous 3 months		**[[Myocardial infarction]] in previous 3 months
	**Arterial puncture at noncompressible site in previous 7 days		**Arterial puncture at noncompressible site in previous 7 days
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	**Only minor and isolated neurologic signs		**Only minor and isolated neurologic signs
	**[[Seizure]] at stroke onset		**[[Seizure]] at stroke onset
	*Persistent SBP >185 or DBP >110 despite treatment		*Persistent [[hypertension\|SBP >185]] or DBP >110 despite treatment
	*Use of direct thrombin inhibitors or direct factor Xa inhibitors with elevated aPTT, INR, or factor Xa assay		*Use of direct thrombin inhibitors (e.g. [[dabigatran]], [[argatroban]]) or direct factor Xa inhibitors (e.g. [[rivaroxaban]], [[apixaban]]) with elevated aPTT, INR, or factor Xa assay
	*Active bleeding or acute trauma (fracture) on exam		*Active bleeding or acute [[trauma]] ([[fracture]]) on exam
	*Labs		*Labs
	**Platelets <100K		**Platelets <100K
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	**INR >1.7 or PT >15 sec if on warfarin		**INR >1.7 or PT >15 sec if on warfarin
	**Elevated PTT if on heparin		**Elevated PTT if on heparin
	*Head CT		*[[Head CT]]
	**Evidence of hemorrhage		**Evidence of [[ICH\|hemorrhage]]
	**Evidence of multilobar infarction with hypodensity involving >33% of cerebral hemisphere		**Evidence of multilobar infarction with hypodensity involving >33% of cerebral hemisphere
	**Intracranial neoplasm, AVM, or aneurysm		**Intracranial neoplasm, [[AVM]], or aneurysm
	*Use of dabigatran within 48hrs is relative contraindication		*Use of dabigatran within 48hrs is relative contraindication

	===Relative Exclusion Criteria===		===Relative Exclusion Criteria===
	*Minor or rapidly improving stroke symptoms		*Minor or rapidly improving stroke symptoms
	*Pregnancy		*[[Pregnancy]]
	*[[Seizure]] at onset with postictal residual neuro impairments		*[[Seizure]] at onset with postictal residual neuro impairments

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	**Combination of both previous stroke and DM		**Combination of both previous stroke and DM
	**NIHSS score >25		**NIHSS score >25
	**Oral anticoagulant use regardless of INR		**Oral [[anticoagulant]] use regardless of INR

	==Administration==		==Administration==

Rossdonaldson1: /* See Also */

2019-03-05T06:16:28Z

Rossdonaldson1: Rossdonaldson1 moved page Thrombolytics in acute ischemic stroke to Thrombolytics for acute ischemic stroke

2019-03-05T06:15:41Z

Rossdonaldson1 moved page Thrombolytics in acute ischemic stroke to Thrombolytics for acute ischemic stroke

← Older revision	Revision as of 06:15, 5 March 2019
(No difference)

Rossdonaldson1: Rossdonaldson1 moved page Thrombolysis in Acute Ischemic Stroke (tPA) to Thrombolytics in acute ischemic stroke

2019-03-05T06:04:46Z

Rossdonaldson1 moved page Thrombolysis in Acute Ischemic Stroke (tPA) to Thrombolytics in acute ischemic stroke

← Older revision	Revision as of 06:04, 5 March 2019
(No difference)

Rossdonaldson1: /* See Also */

2016-12-19T12:13:17Z

Rossdonaldson1: Text replacement - "Seizure " to "Seizure "

2016-09-25T21:29:49Z

Text replacement - "*Seizure " to "*Seizure "

← Older revision		Revision as of 21:29, 25 September 2016
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	**Spontaneously clearing stroke symptoms		**Spontaneously clearing stroke symptoms
	**Only minor and isolated neurologic signs		**Only minor and isolated neurologic signs
	**Seizure at stroke onset		**[[Seizure]] at stroke onset
	*Persistent SBP >185 or DBP >110 despite treatment		*Persistent SBP >185 or DBP >110 despite treatment
	*Use of direct thrombin inhibitors or direct factor Xa inhibitors with elevated aPTT, INR, or factor Xa assay		*Use of direct thrombin inhibitors or direct factor Xa inhibitors with elevated aPTT, INR, or factor Xa assay
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	*Minor or rapidly improving stroke symptoms		*Minor or rapidly improving stroke symptoms
	*Pregnancy		*Pregnancy
	*Seizure at onset with postictal residual neuro impairments		*[[Seizure]] at onset with postictal residual neuro impairments

	==tPA between 3-4.5hrs==		==tPA between 3-4.5hrs==

Rossdonaldson1: Text replacement - "MI " to "Myocardial infarction "

2016-09-24T13:30:24Z

Text replacement - "*MI " to "*Myocardial infarction "

← Older revision		Revision as of 13:30, 24 September 2016
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	**Major surgery in the previous 14 days		**Major surgery in the previous 14 days
	**GI or urinary tract bleeding in previous 21 days		**GI or urinary tract bleeding in previous 21 days
	**MI in previous 3 months		**[[Myocardial infarction]] in previous 3 months
	**Arterial puncture at noncompressible site in previous 7 days		**Arterial puncture at noncompressible site in previous 7 days
	*Clinical		*Clinical

Rossdonaldson1: Text replacement - "ECG" to "ECG"

2016-09-09T08:47:44Z

Text replacement - "*ECG" to "*ECG"

← Older revision		Revision as of 08:47, 9 September 2016
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	**Only need to wait for result if suspicion of abnormal value, patient has received heparin or warfarin, or use of anticoagulants is unknown		**Only need to wait for result if suspicion of abnormal value, patient has received heparin or warfarin, or use of anticoagulants is unknown
	*Glucose		*Glucose
	*ECG		*[[ECG]]
	*Urine pregnancy (pregnancy is relative contraindication)		*Urine pregnancy (pregnancy is relative contraindication)

Rossdonaldson1: /* Exclusion Criteria */

2016-08-25T23:35:01Z

Exclusion Criteria

← Older revision		Revision as of 23:35, 25 August 2016
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	*Active bleeding or acute trauma (fracture) on exam		*Active bleeding or acute trauma (fracture) on exam
	*Labs		*Labs
	**Platelets < 100K		**Platelets <100K
	**Serum glucose < 50, > 400		**Serum glucose <50, >400
	**INR > 1.7 or PT > 15 sec if on warfarin		**INR >1.7 or PT >15 sec if on warfarin
	**Elevated PTT if on heparin		**Elevated PTT if on heparin
	*Head CT		*Head CT

← Older revision		Revision as of 06:16, 5 March 2019
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	*[[NIH Stroke Scale]]		*[[NIH Stroke Scale]]
	*[[EBQ:Studies List of Thrombolytics for Acute Stroke\|List of studies: Thrombolytics in CVA]]		*[[EBQ:Studies List of Thrombolytics for Acute Stroke\|List of studies: Thrombolytics in CVA]]
			*[[Thrombolytics]]

	==References==		==References==

← Older revision		Revision as of 12:13, 19 December 2016
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	*[[Post-tPA Hemorrhage in CVA]]		*[[Post-tPA Hemorrhage in CVA]]
	*[[NIH Stroke Scale]]		*[[NIH Stroke Scale]]
	*[[EBQ:~~Studies_List_of_Thrombolytics_for_Acute_Stroke~~\|List of studies: Thrombolytics in CVA]]		*[[EBQ:Studies List of Thrombolytics for Acute Stroke\|List of studies: Thrombolytics in CVA]]

	==References==		==References==

Thrombolytics for acute ischemic stroke - Revision history

Danbot: Add peer-reviewed reference

ClaireLewis at 22:44, 1 October 2019

Rossdonaldson1: /* See Also */

Rossdonaldson1: Rossdonaldson1 moved page Thrombolytics in acute ischemic stroke to Thrombolytics for acute ischemic stroke

Rossdonaldson1: Rossdonaldson1 moved page Thrombolysis in Acute Ischemic Stroke (tPA) to Thrombolytics in acute ischemic stroke

Rossdonaldson1: /* See Also */

Rossdonaldson1: Text replacement - "*Seizure " to "*Seizure "

Rossdonaldson1: Text replacement - "*MI " to "*Myocardial infarction "

Rossdonaldson1: Text replacement - "*ECG" to "*ECG"

Rossdonaldson1: /* Exclusion Criteria */

Rossdonaldson1: Text replacement - "Seizure " to "Seizure "

Rossdonaldson1: Text replacement - "MI " to "Myocardial infarction "

Rossdonaldson1: Text replacement - "ECG" to "ECG"