Chapter 24 – Stroke Prévention (QE) Sample Questions
1. KT is an 80-year-old patient who presents to the emergency room due to suspected symptoms of acute stroke. Doctor confirms the diagnosis supported by positive Troponin and Electrocardiogram (ECG). KT’s arrival at ER is after 1 hour of stroke symptoms. Currently, patient’s blood pressure is 190/110. Previously, KT received treatment for intracranial hemorrhagic stroke, almost a month ago. At present, his trip to ER is due to new stroke symptoms. KT’s surgeons are reluctant to treat him with Alteplase. Which of the following could be KTs absolute contraindication of Alteplase?
- A. Smoker
- B. Previous intracranial hemorrhagic stroke
- C. Age >78-year old
- D. Arriving to emergence after 1 hour
Ans:
B
Tips: ACTIVASE rtPA (alteplase) therapy is contraindicated in the following situations because of an increased risk of bleeding, which could result in significant disability or death; symptom onset greater than 3 hours; evidence of intracranial hemorrhage on pretreatment evaluation; Suspicion of subarachnoid hemorrhage on pretreatment evaluation; recent intracranial surgery or intraspinal surgery, serious head trauma or previous stroke (within 3 months); history of intracranial hemorrhage; uncontrolled hypertension at the time of treatment (e.g., >185 mm Hg systolic or >110 mm Hg diastolic).
Aggressive treatment required to reduce blood pressure to specified limits. Seizure at the onset of stroke
• Active internal bleeding
• Intracranial neoplasm, arteriovenous malformation, or aneurysm
• Major surgery within 14 days
• Gastrointestinal hemorrhage or urinary tract hemorrhage within the previous 21 days
• Arterial puncture at a noncompressible site within the previous 7 days
• Blood glucose <3 or >22 mmol/L (<50 mg/dL or >400 mg/dL)
• Recent myocardial infarction (<3 months) and/or clinical presentation associated with post-myocardial infarction pericarditis.
• Known bleeding diathesis including but not limited to: Current use of oral anticoagulants (e.g., warfarin sodium) or an International Normalized Ratio (INR) >1.7 or a prothrombin time (PT) >15 seconds.
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