Contraindications to fibrinolysis

Recombinant tissue-type plasminogen (rtPA)

100 mg over 2 h


Ø History of hemorrhagic stroke or stroke of unknown origin

Ø Ischemic stroke in previous 6 months

Ø CNS neoplasm

Ø Major trauma, surgery, or head injury in previous 3 weeks

Ø Bleeding diathesis

Ø Active bleeding

0.6 mg/kg over 15 min (maximum dose 50 mg)


250,000 IU as a loading over 30 min, followed by 100,000 IU/h over 12 - 24 h

Accelerated regimen: 1.5 million IU over 2 h


4400 IU/kg as a loading dose over 10 min, followed by 4400 IU/kg/h over 12 - 24 h


Ø Transient ischemic attack in previous 6 months

Ø Oral anticoagulation

Ø Pregnancy or first postpartum week

Ø Non-compressible puncture sites

Ø Traumatic resuscitation

Ø Refractory hypertension (systolic BP > 180 mmHg)

Ø Advanced liver disease

Ø Infective endocarditis

Ø Active peptic ulcer

Accelerated regimen: 3 million IU over 2 h