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Exclusion Criteria - Significant head trauma or prior stroke in previous 3 months - Symptoms suggest subarachnoid hemorrhage - History of previous intracranial hemorrhage - Intracranial neoplasm, arteriovenous malformation, or aneurysm - Recent intracranial or intraspinal surgery - Arterial puncture at noncompressible site in previous 7 days - Elevated blood pressure (systolic >185 mm Hg or diastolic >110 mm Hg) - Active internal bleeding - Blood glucose concentration <50mg/dl (2.7mmol/L) - Acute bleeding diathesis, including but not limited to: Platelet count <100 000/mm³ (In patients without history of thrombocytopenia, treatment with IV rtPA can be initiated before availability of platelet count but should be discontinued if platelet count is <100 000/mm³.) - Heparin received within 48 hours, resulting in abnormally elevated aPTT greater than the upper limit of normal - Current use of anticoagulant with INR >1.7 or PT >15 seconds (In patients without recent use of oral anticoagulants or heparin, treatment with IV rtPA can be initiated before availability of coagulation test results but should be discontinued if INR is >1.7 or PT is abnormally elevated by local laboratory standards.) - Current use of direct thrombin inhibitors or direct factor Xa inhibitors with elevated sensitive laboratory tests (such as aPTT, INR, platelet count, and ECT; TT; or appropriate factor Xa activity assays) - CT demonstrates multilobar infarction (hypodensity >1/3 cerebral hemisphere) Relative Exclusion Criteria Recent experience suggests that under some circumstances—with careful consideration and weighting of risk to benefit—patients may receive fibrinolytic therapy despite 1 or more relative contraindications. Consider risk to benefit of IV rtPA administration carefully if any of these relative contraindications are present: - Only minor or rapidly improving stroke symptoms (clearing spontaneously) - Seizure at onset with postictal residual neurological impairments - Major surgery or serious trauma within previous 14 days - Recent gastrointestinal or urinary tract hemorrhage (within previous 21 days) - Pregnancy



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