33
Table 6. Other Situations Wherein Thrombolysis is Deemed
to be Considered
Conditions that are relative contraindications
Pregnancy and
post-partum
period
IV thrombolysis may be considered in pregnancy and post-partum
period when the benefits of treating moderate or severe stroke
outweighs the anticipated risk of uterine bleeding. Emergent
obstetrical consultation is warranted.
Dural puncture
w/in 7 days
IV thrombolysis for patients with AIS post-dural puncture may
be considered in individual cases, even in instances when they may
have undergone a lumbar dural puncture in the preceding 7 days.
Arterial puncture
w/in 7 days
The safety of IV thrombolysis in patients with AIS who have
had an arterial puncture of a noncompressible blood vessel (eg,
subclavian artery line) in the 7 days preceding the stroke symptoms
is unknown.
Moderate to
severe traumatic
brain injury ≥14
days to 3 months
IV thrombolysis may be considered in AIS patients with recent
moderate to severe traumatic brain injury (between 14 days and
3 months). Careful consideration should be made based on the
type and severity of traumatic injury and in consultation with
neurosurgical and neurocritical care team members.
Neurosurgery ≥14
days to 3 months
For patients with AIS and a history of intracranial/spinal
surgery between 14 days and 3 months, IV thrombolysis may be
considered on an individual basis. Consultation with neurosurgical
team members is recommended.
Conditions that are considered absolute contraindications
CT with extensive
hypodensity
IV thrombolysis should not be administered to patients whose
brain imaging exhibits regions of clear hypodensity that appear
to be responsible for the clinical symptoms of stroke. Clear
hypodensity is when the degree of hypodensity is greater than the
density of contralateral unaffected white matter.
CT with
hemorrhage
IV thrombolysis should not be administered to patients whose CT
brain imaging reveals an acute intracranial hemorrhage.
Moderate to
severe traumatic
brain injury
<14 days
IV thrombolysis is likely contraindicated in AIS patients with
recent moderate to severe traumatic brain injury (within 14 days)
that incurred >30 minutes of unconsciousness and Glasgow Coma
Scale of <13 OR evidence of hemorrhage, contusion, or skull
fracture on neuroimaging.
Neurosurgery
<14 days
For patients with AIS and a history of intracranial/spinal surgery
within 14 days, IV thrombolysis is potentially harmful and should
not be administered.
(cont'd)
