The current AHA/ASA guidelines for thrombolytics in stroke recommend treatment for patients who fit the following profile: Patients must have a measurable neurologic deficit that is not clearing spontaneously and is not minor and isolated. In those with severe deficits and a National Institutes of Health Stroke Scale (NIHSS) > 22, caution is advised because although there may be some benefit to therapy, there is a significant increase in the risk of intracranial hemorrhage. The patient in choice E does not have any contraindications for tPA therapy. [see for table of contraindications]

An INR >1.7 (A) is a contraindication. Blood glucose less than 50 mg/dL (B) is a contraindication. Any history of an intracranial bleed (C) is a contraindication to tPA therapy. History of head trauma in the preceding 3 months (D) is a contraindication to tPA therapy.


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