Table 1

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)

DomainContraindicationChange over time
Time delaysThrombolysis time window >180 minThrombolysis 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 <6NIHSS <4, unless hemianopia or aphasia since October 2006
* Too severe: NIHSS >25No upper NIHSS-limit since October 2006
* Any ‘rapid improvement’ (not quantified)Rapid improvement reaching NIHSS <4 since September 2006
Age limit* >80 yearsNo age limit since October 2006, unless significant pre-existing disability
Imaging contraindicationsPlain 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 riskINR >1.2INR >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 reasonsNo good reason (thrombolysis opportunity missed)
Recent ischaemic stroke or brain trauma <3 months
Stroke diagnosis uncertain
* Concomitant epileptic seizureThrombolysis 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.