Contraindications for Intravenous Thrombolysis in Acute Cerebral Infarction

Intravenous thrombolysis is a critical treatment option for patients suffering from acute ischemic stroke. However, there are several contraindications that must be carefully evaluated before proceeding with this therapy. These precautions are essential to minimize the risk of complications, particularly hemorrhagic transformation.

Key Contraindications to Consider

1. History of Intracranial Hemorrhage or Vascular Abnormalities

Patients with a prior history of cerebral hemorrhage, subarachnoid hemorrhage, or known vascular anomalies such as aneurysms or arteriovenous malformations are at significantly increased risk of bleeding. Additionally, individuals with intracranial tumors may also face elevated hemorrhage risks during thrombolytic therapy and are generally not considered suitable candidates.

2. Recent Major Surgery or Hemorrhagic Events

Individuals who have undergone major surgical procedures within the last three months or experienced a significant gastrointestinal bleed within the same timeframe are not ideal candidates for intravenous thrombolysis. Similarly, those who have suffered an ischemic or hemorrhagic stroke within the past three weeks should avoid this treatment due to the increased likelihood of bleeding complications.

3. Recent Trauma or Invasive Procedures

Patients who have experienced an acute gastric perforation in the last two weeks or have undergone a major arterial puncture that cannot be easily compressed within the past seven days should not undergo thrombolytic therapy. These conditions increase the risk of uncontrolled bleeding and complicate post-procedural management.

4. Active Bleeding or Anticoagulant Use

Active bleeding from traumatic injuries or other causes is a clear contraindication. Additionally, patients who have recently taken anticoagulants or antiplatelet medications leading to an international normalized ratio (INR) greater than 1.5 are at high risk for hemorrhagic complications and should not receive thrombolytic treatment.

5. Recent Use of Antiplatelet or Anticoagulant Medications

If a patient has ingested antiplatelet agents or anticoagulants within the last 48 hours, thrombolytic therapy is typically not recommended. These medications can impair normal clotting mechanisms and increase the risk of severe bleeding during or after treatment.

Conclusion

Proper patient selection is vital when considering intravenous thrombolysis for acute cerebral infarction. A thorough understanding of the contraindications helps ensure patient safety and improves clinical outcomes. Physicians must carefully evaluate each case and weigh the potential benefits against the risks associated with this powerful treatment modality.