Contraindications to intravenous rtPA for acute stroke: A critical reappraisal

Only 1%-5% of patients with acute ischemic stroke presenting within 3 hours of symptoms receive IV recombinant tissue plasminogen activator (rtPA)- the only effective treatment available. The administration of rtPA is limited by extensive exclusion criteria, many of which are not based on evidence, but rather derived from expert opinion for large stroke trials. Over the past 15 years, experiences with the use of rtPA in clinical practice have led to evidence suggesting that several of the current contraindications for rtPA are unnecessary and overly restrictive. In this review, we analyze the evidence-most of which is derived from observational research- supporting or contradicting current contraindications for administering IV rtPA to acute ischemic stroke patients.