34
General Supportive Early Management
Table 6. Other Situations Wherein Thrombolysis is Deemed
to be Considered
Conditions that are considered absolute contraindications
Acute spinal cord
injury within
3 months
IV thrombolysis is likely contraindicated in AIS patients with
spinal cord injury within 3 months
Intra-axial
neoplasm
For patients with AIS who harbor an intra-axial intracranial
neoplasm, treatment with IV thrombolysis is potentially harmful
and should not be administered.
Infective
endocarditis
For patients with AIS and symptoms consistent with infective
endocarditis, treatment with IV thrombolysis should not be
administered.
Severe
coagulopathy or
thrombocytopenia
The safety and efficacy of IV thrombolysis for AIS in patients
with platelets <100,000/mm
3
, INR>1.7, aPTT>40s, or PT>15s
is unknown though may substantially increase risk of harm and
should not be administered.
In patients without recent use of warfarin or heparin, treatment
with IV thrombolysis can be initiated before availability of
coagulation test results but should be discontinued if INR>1.7,
PT, or PTT is abnormal by local laboratory standards.
Aortic arch
dissection
For patients with AIS and known or suspected aortic arch
dissection, treatment with IV thrombolysis is potentially harmful
and should not be administered.
Amyloid-
related imaging
abnormalities
(ARIA)
The risk of thrombolysis related ICH in patients on amyloid
immunotherapy or with ARIA is unknown and IV thrombolysis
should be avoided in such patients.
AIS indicates acute ischemic stroke; aPTT, activated partial thromboplastin time; CNS,
central nervous system; CT, computed tomography; DOAC, direct oral anticoagulant; GI,
gastrointestinal; GU, genitourinary; HTN, hypertension; ICH, intracerebral hemorrhage;
INR, international normalized ratio; IRB, institutional review board; IV, intravenous; MI,
myocardial infarction; PT, prothrombin time; and PTT, partial thromboplastin time.
Light Teal: Indicates scenarios with relatively low concerns but not linked to actionable
recommendations.
Peach: Indicates moderate caution where additional consideration may be warranted.
Pinkish Red: Indicates higher relative harm requiring careful examination but remains
unsupported by clinical evidence.
(cont'd)
