ICH 3/100 develop intracranial bleed
Indications Inability to get a cath lab
Hypertension 200/110
R/O aortic Dissection Difference in BP of arms >15mmhg
CNS Bleed Hx /Stroke hx/trauma/GI bleed/pregnancy
Absolute contraindications
If any of these factors exist, you should NOT administer a fibrinolytic agent1:
- History of any intracranial hemorrhage
- History of ischemic stroke within the preceding three months (unless it is an acute ischemic stroke occurring within the last three hours, then fibrinolysis is useful!)
- Presence of a cerebral vascular malformation or a primary or metastatic intracranial malignancy
- Symptoms or signs suggestive of an aortic dissection
- A bleeding diathesis or active bleeding, (menstruation is an exception)
- Significant closed-head or facial trauma within the preceding three months.
Relative contraindications
If any of these factors exist, you should consider NOT administering a fibrinolytic agent1:
- Severe hypertension or uncontrolled hypertension (blood pressure >180 mm Hg systolic and/or >110 mm Hg diastolic
- Ischemic stroke longer than three months ago
- Dementia
- Any known intracranial disease that is not an absolute contraindication
- If cardiopulmonary resuscitation was administered for >10 min
- Major surgery within the last three weeks
- Internal bleeding within the last two to four weeks
- Vascular punctures that could not be compressed if they were to start bleeding
- Pregnancy
- Currently on warfarin therapy
- Any allergic reaction to fibrinolytic drugs in the past