Contraindications to thrombolytic therapy

Absolute contraindications [NB1]

• any prior intracranial haemorrhage
• known structural cerebral vascular lesion (eg arteriovenous malformation)
• known malignant intracranial neoplasm (primary or metastatic)
• ischaemic stroke within 3 months, except acute ischaemic stroke within 4.5 hours
• suspected aortic dissection
• active bleeding or bleeding diathesis (excluding menses)
• significant closed head or facial trauma within 3 months

Relative contraindications [NB1]

• history of chronic, severe, poorly controlled elevated blood pressure
• severely elevated blood pressure on presentation (more than 180 mmHg systolic or more than 110 mmHg diastolic)
• ischaemic stroke more than 3 months ago, dementia, or known intracranial abnormality not covered as an absolute contraindication
• traumatic or prolonged (more than 10 minutes) cardiopulmonary resuscitation
• recent (within 3 weeks) major surgery
• recent (within 4 weeks) internal bleeding (eg gastrointestinal or urinary tract haemorrhage)
• noncompressible vascular punctures in the past 24 hours (eg liver biopsy, lumbar puncture)
• pregnancy or within 1 week postpartum
• active peptic ulcer disease
• current use of anticoagulants
• advanced liver disease
• infective endocarditis
• transient ischaemic attack in the preceding 6 months