Absolute Contraindications for Thrombolysis in Ischemic Stroke

Hemorrhagic and Cerebrovascular Contraindications

• The American College of Cardiology recommends that any prior intracranial hemorrhage at any time is an absolute contraindication for thrombolysis in acute ischemic stroke, due to increased risk of recurrent bleeding 1, 2
• The American College of Cardiology and European Heart Journal state that ischemic stroke within the preceding 3 months represents an absolute contraindication due to increased risk of hemorrhagic transformation 1, 3
• The American College of Cardiology and Circulation guidelines indicate that known structural cerebral vascular lesions, including arteriovenous malformations, are absolute contraindications for thrombolysis in acute ischemic stroke 1, 2
• The American College of Cardiology and Circulation guidelines state that known malignant intracranial neoplasm is an absolute contraindication for thrombolysis in acute ischemic stroke 1, 2

Recent Trauma and Surgery

• The American College of Cardiology recommends that intracranial or intraspinal surgery within 2 months is an absolute contraindication for thrombolysis in acute ischemic stroke 1
• The European Heart Journal and American College of Cardiology guidelines indicate that recent major trauma, surgery, or head injury within the preceding 3 weeks is an absolute contraindication for thrombolysis in acute ischemic stroke 1, 3
• The American College of Cardiology recommends that significant closed-head or facial trauma within 3 months is an absolute contraindication for thrombolysis in acute ischemic stroke 1

Active Bleeding and Coagulation Disorders

• The American College of Cardiology and Circulation guidelines state that active bleeding or bleeding diathesis, excluding menses, is an absolute contraindication for thrombolysis in acute ischemic stroke 1, 2
• The European Heart Journal and American College of Cardiology guidelines indicate that gastrointestinal bleeding within the last month is an absolute contraindication for thrombolysis in acute ischemic stroke 1, 3
• The European Heart Journal guidelines state that known bleeding disorder is an absolute contraindication for thrombolysis in acute ischemic stroke 3, 4

Cardiovascular Contraindications

• The American College of Cardiology, European Heart Journal, and Circulation guidelines indicate that suspected aortic dissection is an absolute contraindication for thrombolysis in acute ischemic stroke, due to catastrophic risk of rupture 1, 2, 4

Blood Pressure Criteria

• The American College of Cardiology recommends that severe uncontrolled hypertension unresponsive to emergency therapy is an absolute contraindication for thrombolysis in acute ischemic stroke 1

Additional Procedural Contraindications

• The European Heart Journal guidelines state that non-compressible punctures within the past 24 hours are absolute contraindications for thrombolysis in acute ischemic stroke 3

Important Clinical Distinctions

• The American College of Cardiology and European Heart Journal guidelines emphasize that the distinction between absolute and relative contraindications can become blurred in life-threatening situations, but absolute contraindications should be strictly observed in ischemic stroke 1, 3