tPA contraindications in acute ischemic stroke

# Description:
null
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# Inputs:
# Eligibility for tPA
A. Age >= 18 years
B. Clinical diagnosis of ischemic stroke causing neurological deficit
C. Onset of symptoms < 3 hours
# Absolute contraindications to tPA
D. Multilobar infarction on computed tomography (hypodensity > 1/3 cerebral hemisphere)
E. Significant head trauma or prior stroke in the past 3 months
F. Symptoms suggesting subarachnoid hemorrhage
G. History of previous intracranial hemorrhage
H. Recent intracranial or intraspinal surgery
I. Intracranial neoplasm, arteriovenous malformation, or aneurysm
J. Arterial puncture at a noncompressible site in the past 7 days
K. Elevated blood pressure (systolic > 185 mmHg or > diastolic 110 mmHg)
L. Active internal bleeding
M. Acute bleeding diathesis or platelet count < 100,000/mcL
N. Heparin received within 48 hours, resulting in elevated aPTT greater than the upper limit of normal
O. Current use of anticoagulant with INR > 1.7 or PT > 15 seconds
P. 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)
Q. Blood glucose < 50 mg/dL [2.7 mmol/L] 
# Relative contraindications to tPA
R. Only minor or rapidly improving stroke symptoms (clearing spontaneously)
S. Major surgery or serious trauma in the past 14 days
T. Gastrointestinal or urinary tract hemorrhage in the past 21 days
U. Seizure at onset with postictal residual neurological impairments
V. Acute myocardial infarction in the past 3 months
W. Pregnancy
# Additional relative contraindications to tPA, within 3-4.5 hours from onset
X. Age > 80 years
Y. Severe stroke (NIHSS > 25)
Z. Taking an oral anticoagulant regardless of INR
AA. History of both diabetes and prior ischemic stroke
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# Scoring:
- If A and B and C and ((D or E or F or G or H or I or J or K or L or M or N or P or Q) or ((D or E or F or G or H or I or J or K or L or M or N or P or Q) and (R or S or T or U or V or W or X or Y or Z or AA))), then tPA is contraindicated
- If A and B and C and (R or S or T or U or V or W or X or Y or Z or AA), then tPA is relatively contraindicated; discuss the risks versus benefits
- If A and B and C, then Patient is eligible for tPA
- If true, then Contraindications cannot be assessed)

Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association / American Stroke Association.