American Association of Neuroscience Nurses



Excluded 0-3 hour window (III)Reasonable 0-3hr window Benefit >> Risk (IIa)Age less than 18 years or patient/family refusalAny acute intracranial hemorrhage on CT.Intracranial /intraspinal surgery/Serious head injury in past 3 monthsStroke in past 3 monthsWarfarin use with INR over 1.7Prophylactic or treatment dose LMWH within 24 hrsHeparin within 48 hrs with an aPTT > normalPT > 15, aPTT >40 or Platelet count less than100K/mm3.Use of oral FactorXa or direct thrombin inhibitors w/i 48hrs (dabigatran, apixaban, rivaroxaban, edoxaban)Known infective endocarditis. Uncontrollable BP > 185/110 Intracranial conditions that increase the risk of bleeding (tumor, aneurysm, AVM)Current stroke in the context of aortic dissection. Intra-axial intracranial neoplasmActive bleeding or acute traumaExtensive regions of hypoattentuation (stroke) on CTModerate/severe on presentation, improving, but current deficit would disable. DO NOT “WAIT AND SEE.” Known small or moderate sized (<10mm) unruptured cerebral aneurysm. Non-STEMI MI, STEMI MI of right or inferior myocardium Presence of an extra-axial intracranial neoplasmEarly ischemic changes other than frank hypodensity.Stroke as complication of cardiac or cerebral angiographic procedures who meet usual eligibility criteria.Seizure at time of stroke onset Dementia. Consider treatment Currently menstruating womenSuspected psychogenic/Conversion/MalingeringPast GI or GU BleedingPotentially Harmful 0-3 hr windowBenefit > Risk (IIb)Extended Time Frame ( Stroke start 3-4.5hrs prior to arrival) Follow 0-3hr window Exclusions then……Compare Risk/Benefit if :Major surgery or major trauma in previous 14 daysNon-pharmacologic bleeding diathesis/ coagulopathySystemic malignancy and life expectancy > 6 months Puncture of a non-compressible artery within past 7 daysCurrently pregnant or postpartum less than 14 daysSickle Cell disease. Known giant unruptured unsecured aneurysmDementia. Consider life expectancy , level of functionPreexisting disability modified Rankin score > 2Recent or active menorrhagiaMyxoma or papillary fibroelastomaSeverely disabling stroke +LA /LV thrombus/ pericarditisSTEMI of Left anterior myocardium in past 3 monthsStructural GI cancer or bleeding in the last 21 daysNIHSS score over 25 (ClassIIb/C); Benefit > RiskPrior stroke AND diabetes (ClassIIb/B); Benefit > Risk -52682302000Age is not a factor. Alteplase? is recommended for patients over 80 yoa in the 3-4.5 hr. window (Class IIa/B)Benefit > Risk-5334027305Class IIa: treatment is reasonable to administer Benefit >> RiskClass IIb: treatment may be considered Benefit > RiskClass III: HARM no benefit00Class IIa: treatment is reasonable to administer Benefit >> RiskClass IIb: treatment may be considered Benefit > RiskClass III: HARM no benefit Demaerschalk B, et al Scientific Rationale for the Inclusion/Exclusion Criteria for IV Alteplase in Acute Ischemic Stroke. Stroke February 2016Diagnosis and Initial Treatment of Ischemic Stroke/11th ed,/Dec. 2016/ 0-84147 ................
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