TPA Criteria

Question 1

Stratify Stroke Risk.

ABCD-2

Answer 1

Age > 59: 1 point

Blood pressure 140/90 or more: 1 point.

Clinical Sx.: speech only, 1 pt; weakness , 2 pts.

Duration:
10-59 min., 1 point.
> 60 min., 2 points

2-day stroke risk:

Score 0-1: zero

Score 2-3: 1.3%.

Score 4-5: 4%.

Score 6-7: 8%.

Question 2

TPA < 3 hrs.

Inclusion:

Age ≥18
Clinical diagnosis of ischemic stroke causing neurological deficit.

Exclusions?

Answer 2

Exclusions:

Intracranial hemorrhage on CT

Clinical presentation suggests subarachnoid hemorrhage

Neurosurgery, head trauma, or stroke in past 3 months

Uncontrolled hypertension (>185 mmHg SBP or >110 mmHg DBP)

History of intracranial hemorrhage
No
Yes
Known intracranial arteriovenous malformation, neoplasm, or aneurysm
No
Yes
Active internal bleeding
No
Yes
Suspected/confirmed endocarditis
No
Yes
Known bleeding diathesis:
(1) Platelet count < 100,000; (2) Patient has received heparin within 48 hours and has an elevated aPTT (greater than upper limit of normal for laboratory); (3) Current use of oral anticoagulants (ex: warfarin) and INR >1.7; (4)Current use of direct thrombin inhibitors or direct factor Xa inhibitors
No
Yes
Abnormal blood glucose (<50 or >400 mg/dL)

Question 3

TPA

Relative Contraindications?

Answer 3

Only minor or rapidly improving stroke symptoms
No
Yes
Major surgery or serious non-head trauma in the previous 14 days
No
Yes
History of gastrointestinal or urinary tract hemorrhage within 21 days
No
Yes
Seizure at stroke onset
No
Yes
Recent arterial puncture at a noncompressible site
No
Yes
Recent lumbar puncture
No
Yes
Post myocardial infarction pericarditis
No
Yes
Pregnancy

Question 4

TPA 3 - 4.5 hours.

Additional issues

Answer 4

Age >80 years
No
Yes
History of prior stroke and diabetes
No
Yes
Any active anticoagulant use (even with INR <1.7)
No
Yes
NIHSS >25
No
Yes
CT shows multilobar infarction (hypodensity >1/3 cerebral hemisphere)
No
Yes