Contraindications with recombinant tissue plasminogen activator (rt-PA) in acute ischemic stroke population

Abstract Background Most of the exclusion criteria in a stroke population are attributed to demographic, more specific or relative contraindications indicating that thrombolysis maybe beneficial more to a stroke population with less restrictive criteria. Methods We analyzed a three year data set from a large stroke registry on rt-PA administration based on the US Food and Drug Administration (FDA) package insert, explicitly for the use of tissue-type plasminogen activator in acute ischemic stroke. We identified absolute and relative contraindications including specific clinical rationales for exclusion. Results A total of 663 ischemic stroke patients were eligible to receive rt-PA. Out of the 663 acute ischemic stroke patients, 241 received rt-PA and 422 were excluded based on specific absolute and relative exclusionary contraindications. Patients older than 80 years and those with mild or rapidly improving stroke symptoms, and higher NIHSS significantly influenced the decision to exclude stroke patients from rt-PA. Conclusion Contraindications differ with individual patients’ representing commonly encountered clinical situations that support most of the exclusion criteria in both the old FDA package insert and AHA guideline.