Contraindications for thrombolysis in our centre, with changes over time (some further softening of contraindications took place since end of data collection for this analysis)
| Domain | Contraindication | Change over time |
|---|---|---|
| Time delays | Thrombolysis time window >180 min | Thrombolysis time window >270 min since November 2008 |
| Thrombolysis time window >180 min and no indication for intra-arterial treatment within 6 hours (‘too late intravenous and no indication intra-arterial’) | – | |
| Unknown stroke onset and inability to treat within recommended time limits since last proof of good health | – | |
| Initial stroke severity | * Too mild: NIHSS <6 | NIHSS <4, unless hemianopia or aphasia since October 2006 |
| * Too severe: NIHSS >25 | No upper NIHSS-limit since October 2006 | |
| * Any ‘rapid improvement’ (not quantified) | Rapid improvement reaching NIHSS <4 since September 2006 | |
| Age limit | * >80 years | No age limit since October 2006, unless significant pre-existing disability |
| Imaging contraindications | Plain cCT: >30% hypo-attenuation of MCA territory | – |
| In borderline indications: large core on acute perfusion CT and/or little salvageable tissue | – | |
| Large subacute (silent) infarction on imaging, defined as a poorly demarcated, hypodense territorial lesion with mild local swelling or absence of the usual atrophy of chronic stroke lesions | – | |
| Acute intracranial haemorrhage | – | |
| High bleeding risk | INR >1.2 | INR >1.5 since October 2006 |
| Thrombocytopenia <100 000/mm3 | – | |
| Recent surgical intervention <14 days | – | |
| Previous intracranial haemorrhage | – | |
| Intracranial vascular malformation (known or suspected on plain cCT) | – | |
| Full dose heparin or LMWH | – | |
| Other bleeding risk | – | |
| Other reasons | No good reason (thrombolysis opportunity missed) | – |
| Recent ischaemic stroke or brain trauma <3 months | – | |
| Stroke diagnosis uncertain | – | |
| * Concomitant epileptic seizure | Thrombolysis indicated, if imaging confirmed acute ischaemic stroke since 9/2006 | |
| * Comorbidity, severely limiting life expectancy, or pre-stroke dependency, defined as mRS >2 | – |
Asterisk (*) indicates a relative contraindication.
cCT, cranial CT; INR, international normalised ratio; LMWH, low molecular weight heparin; MCA, middle cerebral artery; mRS, modified Rankin Scale; NIHSS, National Institute of Health Stroke Scale score.