ACUTE ISCHEMIC STROKE/t-PA THERAPY INCLUSION/EXCLUSION CRITERIA
Patient: |PATIENT NAME|
IINCLUSION CRITERIA:
1. {FLD:YES NO BUTTON} Age 18 or over.
2. {FLD:YES NO BUTTON} Clinical signs of ischemic stroke causing measurable
neuro deficit.
3. {FLD:YES NO BUTTON} Time of symptom onset is less than 180 minutes before
start of t-PA.
(Any answer of "NO" on inclusion criteria prohibits use of t-PA.)
EXCLUSION CRITERIA:
1.{FLD:YES NO BUTTON} Evidence of intracranial hemorrhage on CT.
2.{FLD:YES NO BUTTON} Minor symptoms or major symptoms, which are rapidly resolving.
3.{FLD:YES NO BUTTON} High clinical suspicion of subarachnoid hemorrhage.
even with normal CT.
4.{FLD:YES NO BUTTON} Active internal (GI or GU) bleeding within 21 days.
5.{FLD:YES NO BUTTON} Known bleeding diathesis, including but not limited
to:
platelet count < 100,000;
heparin within 48 hrs. with PTT > upper limit of normal;
anticoagulant use with PT>15 secs.
6.{FLD:YES NO BUTTON} Within 3 mos. of intracranial surgery, serious head
trauma or stroke.
7.{FLD:YES NO BUTTON} Within 14 days of major surgery or serious trauma.
8.{FLD:YES NO BUTTON} Recent arterial puncture at noncompressable site.
9.{FLD:YES NO BUTTON} Lumbar puncture within 7 days.
10{FLD:YES NO BUTTON} History of intracranial hemorrhage, A-V malformation,
aneurysm or intracranial neoplasm.
11.{FLD:YES NO BUTTON} Seizure at onset of stroke.
12.{FLD:YES NO BUTTON} Recent acute myocardial infarction.
13.{FLD:YES NO BUTTON} Systolic BP > 185 or Diastolic BP > 110 at time of
treatment, requiring aggressive treatment to reduce BP within these limits.
(Any answer of "Yes" on exclusion criteria prohibits use of t-PA.)
No
Yes