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Inclusion criteria |
(i) Diagnosis of ischemic stroke causing measurable neurological deficit |
(ii) Onset of symptoms <3 h before treatment begins |
(iii) Age ≥ 18 y |
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Exclusion criteria |
(i) Significant head trauma or prior stroke in the previous 3 months |
(ii) Symptoms suggest SAH |
(iii) Arterial puncture at noncompressible site in previous 7 d |
(iv) History of previous intracranial hemorrhage |
(v) Intracranial neoplasm, AVM, or aneurysm |
(vi) Recent intracranial or intraspinal surgery |
(vii) Elevated blood pressure (systolic > 185 mmHg or diastolic > 110 mmHg) |
(viii) Active internal bleeding |
(ix) Acute bleeding diathesis, including but not limited to |
(x) Platelet count < 100000/mm3 |
(xi) Heparin received within 48 h resulting in abnormally elevated aPTT above the upper limit of normal |
(xii) Current use of anticoagulant with INR > 1.7 or PT > 15 s |
(xiii) Current use of direct thrombin inhibitors or direct factor Xa inhibitors with elevated sensitive laboratory tests (e.g., aPTT, INR, platelet count, ECT, TT, or appropriate factor Xa activity assays) |
(xiv) Blood glucose concentration <50 mg/dL (2.7 mmol/L) |
(xv) CT demonstrates multilobar infarction (hypodensity > 1/3 cerebral hemisphere) |
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Relative exclusion criteria |
(i) Recent experience suggests that under some circumstances, with careful consideration and weighting of risk to benefit, patients may receive fibrinolytic therapy despite ≥1 relative contraindications. Consider risk to benefit of intravenous tPA administration carefully if any of these relative contraindications is present |
(ii) Only minor or rapidly improving stroke symptoms (clearing spontaneously) |
(iii) Pregnancy |
(iv) Seizure at onset with postictal residual neurological impairments |
(v) Major surgery or serious trauma within previous 14 d |
(vi) Recent gastrointestinal or urinary tract hemorrhage (within previous 21 d) |
(v) Recent acute myocardial infarction (within previous 3 months) |
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