32
General Supportive Early Management
Table 6. Other Situations Wherein Thrombolysis is Deemed
to be Considered
Conditions that are relative contraindications
Recent major
non-CNS surgery
w/in 10 days
Patients with recent major surgery within 10 days of AIS may
be at increased risk of harm from IV thrombolysis. Individual
consideration of risk vs benefit, surgical area, and consultation
with surgical experts are appropriate.
Recent GI/GU
bleeding w/in
21 days
Patients with recent GI or GU bleeding within 21 days of their
AIS may be at increased risk of harm from IV thrombolysis.
Individual consideration of risk vs benefit and consultation with
GI or GU experts to determine if the GI/GU bleeding has been
treated and risk modified/reduced is recommended.
Intracranial
arterial dissection
The safety of IV thrombolysis in patients with AIS due to
intracranial arterial dissection is unknown.
Intracranial
vascular
malformations
The safety of IV thrombolysis for patients presenting with
AIS who are known to harbor an unruptured and untreated
intracranial vascular malformation is unknown.
Recent STEMI
w/in 3 months
Patients with recent STEMI may be at risk for increased harm
from IVT. For patients with history of STEMI within 3 months,
individual consideration of risk and benefit should be determined
in conjunction with an emergent cardiolog y consultation. For
patients with very recent STEMI (previous several days), the risk
of hemopericardium should be considered relative to potential
benefit. For patients presenting with concurrent AIS and acute
STEMI, treatment with IV thrombolysis should be at a dose
appropriate for cerebral ischemia and in conjunction with emergent
cardiolog y consultation. Consideration of timing, type and severity
of STEMI to determine the risk vs benefit is warranted.
Acute pericarditis IV thrombolysis for patients with major AIS likely to produce
severe disability and acute pericarditis, may be reasonable in
individual cases. Emergent cardiologic consultation is warranted.
Le atrial or
ventricular
thrombus
IV thrombolysis for patients with known left atrial or ventricular
thrombus presenting with major AIS likely to produce severe
disability may be reasonable in individual cases. Emergent
cardiologic consultation is warranted.
Systemic active
malignancy
The safety of IV thrombolysis in patients with systemic active
malignancy is unknown. Emergent consultation with oncolog y to
assess risk/benefit is warranted. Consideration of type, stage, and
active complications of cancer to determine the risk vs benefit is
warranted.
(cont'd)
