What are the key contraindications to thrombolysis in acute stroke?

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Accepted Answer

I would divide contraindications into imaging, bleeding risk, anticoagulation, BP and clinical factors. Imaging: any intracranial haemorrhage on CT. Recent bleeding or high bleeding risk: recent major surgery or trauma, recent intracranial haemorrhage, active internal bleeding. Coagulation: platelets under 100, INR over 1.7, therapeutic anticoagulation with significant coagulopathy. Severe uncontrolled hypertension: BP over 185/110. Other important contraindications include recent ischaemic stroke within the last 3 months, intracranial tumour or vascular malformation, and suspicion of aortic dissection or infective endocarditis. So before thrombolysis we ensure CT excludes haemorrhage, review coagulation, and ensure BP is controlled.

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