NCEMI eTools

TPA for acute stroke - indications/contraindications
tPA for acute stroke
Score: 0
Do NOT thrombolyse - it is contraindicated!
Assessment
15Thrombolysis is indicated!
13-14Thrombolysis more risky, but benefits potentially greater
<13Do NOT thrombolyse - it is contraindicated!
 
Evidence of intracranial hemorrhage (e.g. on CT scan)?
Yes -5 points
No 1 points
 
Suspicion of subarachnoid hemorrhage?
Yes -5 points
No 1 points
 
Recent intracranial surgery or serious head trauma or recent prior stroke?
Yes -5 points
No 1 points
 
History of intracranial hemorrhage?
Yes -5 points
No 1 points
 
Uncontrolled hypertension at treatment time (over 185 systolic or over 110 diastolic)?
Yes -5 points
No 1 points
 
Seizure at stroke onset?
Yes -5 points
No 1 points
 
Active internal bleeding?
Yes -5 points
No 1 points
 
Intracranial neoplasm, arteriovenous malformation, or aneurysm?
Yes -5 points
No 1 points
 
Known bleeding diathesis?
Yes -5 points
No 1 points
 
Current oral anticoagulant use with PT over 15?
Yes -5 points
No 1 points
 
Use of heparin within last 48 hours and elevated PTT?
Yes -5 points
No 1 points
 
Platelet count under 100,000?
Yes -5 points
No 1 points
 
Stroke symptom onset more than 3 hours ago?
Yes -5 points
No 1 points
 
Severe neurologic deficit (e.g. NIHSS over 22)?
Yes 0 points
No 1 points
 
Major early infarct signs on CT (substantial edema, mass effect, or midline shift)?
Yes 0 points
No 1 points
Calculate

Copyright 1995-2004 by National Center for Emergency Medicine Informatics. All Rights Reserved.