Known hypersensitivity to alteplase, gentamicin, or to any of the excipients (arginine, diluted phosphoric acid, polysorbate 80). High risk of haemorrhage (significant bleeding disorder at present or w/in the past 6 mth; known haemorrhagic diathesis; patients receiving effective oral anticoagulant treatment eg, warfarin Na (INR >1.3); manifest or recent severe or dangerous bleeding; known history of or suspected intracranial haemorrhage (ICH); suspected subarachnoid haemorrhage or condition after subarachnoid haemorrhage from aneurysm; any history of CNS damage (ie, neoplasm, aneurysm, intracranial or spinal surgery); recent (<10 days) traumatic external heart massage, obstetrical delivery, recent puncture of a non-compressible blood vessel (eg, subclavian or jugular vein puncture); severe uncontrolled arterial HTN; bacterial endocarditis, pericarditis; acute pancreatitis; documented ulcerative GI disease during the last 3 mth, oesophageal varices, arterial aneurysm, arterial/venous malformations; neoplasm w/ increased bleeding risk; severe liver disease, including hepatic failure, cirrhosis, portal HTN (oesophageal varices) & active hepatitis; major surgery or significant trauma in past 3 mth). Any known history of haemorrhagic stroke or stroke of unknown origin. Known history of ischaemic stroke or transient ischaemic attack in the preceding 6 mth except current acute ischaemic stroke w/in 4.5 hr. Symptoms of ischaemic attack beginning more than 4.5 hr prior to infusion start or symptoms for which the onset time is unknown & could potentially be more than 4.5 hr ago. Minor neurological deficit or symptoms rapidly improving before start of infusion. Severe stroke as assessed clinically (eg, NIHSS >25) &/or by appropriate imaging techniques. Seizure at onset of stroke. Evidence of ICH on the CT-scan. Symptoms suggestive of subarachnoid haemorrhage, even if CT-scan is normal. Administration of heparin w/in the previous 48 hr & a thromboplastin time exceeding ULN. Patients w/ any history of prior stroke & concomitant diabetes. Prior stroke w/in the last 3 mth. Platelet count of <100,000/mm
3. Systolic BP >185 mmHg or diastolic BP >110 mmHg, or aggressive management (IV pharmacotherapy) necessary to reduce BP to these limits. Blood glucose <50 mg/dL or >400 mg/dL (<2.8 mM or >22.2 mM). Childn <16 yr for the treatment of acute ischaemic stroke.
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