Inclusion
1. Symptom onset or last seen normal clearly established to be < 3 hours
(Note: if patient has had TIA/s ensure that patient clearly returned to normal
after each event. Otherwise patient is likely to have had a stroke and is
therefore not a candidate. Additionally, patients waking with symptoms should
be considered to have last been normal at time of retiring)
2. NIHSS > 4
3. Age > 18 years
Exclusion
1. CT Brain with any hemorrhage (Note: patients with large hypodensities in
appropriate region on CT should be questioned in greater detail regarding
true time of onset or last seen normal)
2. BP > 185/110 at time of treatment (Note: patient may receive prn meds
to reduce BP to within this range prior to treatment, but if aggressive treatment
is required or it is felt by treating physician that BP is not stable with
these measures patient should be excluded)
3. Rapidly improving symptoms
4. Clinical history suggestive of subarachnoid hemorrhage even with normal
CT.
5. INR > 1.5 or receiving heparin with elevated PTT (Note: patients receiving
heparin but have a normal PTT prior to treatment may still be considered eligible
candidates)
6. Platelets < 100 K ( Note: this is not an absolute value. Rather, patients
with low platelet counts should be considered to have an underlying coagulopathy
and therefore are at risk for hemorrhage due to coagulopathy and not because
of absolute platelet count)
7. History of one of the following
- Intracranial hemorrhage/Neoplasm/AVM
- Stroke or head trauma in last 3 months
- GI or GU hemorrhage in last 21 days
- Major surgery (in last 14 days)
- Arterial puncture at non-compressible site in last 7 days
- LP in past 24 hrs
8. Glucose < 50 or > 400 (Note: this may be corrected to see if symptoms
resolve. If they do not resolve with normalization of values then patient
may be considered eligible)
9. Recent MI with or without presumed pericarditis
10. Presumed septic embolus
