Absolute contraindications |
History of any intracranial hemorrhage |
History of ischemic stroke within the preceding three months, with the important exception of acute ischemic stroke seen within three hours, which may be treated with thrombolytic therapy |
Presence of a cerebral vascular malformation or a primary or metastatic intracranial malignancy |
Symptoms or signs suggestive of an aortic dissection |
A bleeding diathesis or active bleeding, with the exception of menses; thrombolytic therapy may increase the risk of moderate bleeding, which is offset by the benefits of thrombolysis |
Significant closed-head or facial trauma within the preceding three months |
Relative contraindications |
History of chronic, severe, poorly controlled hypertension or uncontrolled hypertension at presentation (eg, blood pressure >180 mmHg systolic and/or >110 mmHg diastolic; severe hypertension at presentation can be an absolute contraindication in patients at low risk) |
History of ischemic stroke more than three months previously |
Dementia |
Any known intracranial disease that is not an absolute contraindication |
Traumatic or prolonged (>10 min) cardiopulmonary resuscitation |
Major surgery within the preceding three weeks |
Internal bleeding within the preceding two to four weeks or an active peptic ulcer |
Noncompressible vascular punctures |
Pregnancy |
Current warfarin therapy; the risk of bleeding increases as the INR increases |
For streptokinase or anistreplase, a prior exposure (more than five days previously) or allergic reaction to these drugs |
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