cliot (version 1.0.0)

check_tpa_contraindications: tPA Contraindications for Ischemic Stroke

Description

Evaluates a patient for contraindications to intravenous tissue plasminogen activator (tPA) therapy for acute ischemic stroke. This function checks standard exclusion criteria based on AHA/ASA guidelines, including timing, history of hemorrhage, recent surgery/trauma, severe hypertension, and coagulopathy.

Usage

check_tpa_contraindications(symptom_duration_hours, age, disability_status, ich_history,
                            intracranial_neoplasm_avm_aneurysm,
                            recent_intracranial_spinal_surgery, active_internal_bleeding,
                            suspected_aortic_dissection, severe_uncontrolled_hypertension,
                            recent_stroke, recent_head_trauma, current_anticoagulant_use,
                            platelet_count, inr, aptt, pt, glucose)

Value

A list containing:

Recommendation

"tPA Contraindicated" or "tPA May be Indicated".

Contraindications_Present

A list of specific contraindications identified.

Arguments

symptom_duration_hours

Numeric. Time from onset of symptoms (or last known normal) in hours. (> 4.5 hours is a contraindication).

age

Numeric. Patient age in years. (Age > 80 is a relative contraindication in the 3-4.5h window).

disability_status

Numeric (0 or 1). Severe disability prior to stroke (mRS > 1). (Often a relative contraindication).

ich_history

Numeric (0 or 1). History of intracranial hemorrhage. (1 = Yes).

intracranial_neoplasm_avm_aneurysm

Numeric (0 or 1). Presence of intracranial neoplasm, arteriovenous malformation, or aneurysm. (1 = Yes).

recent_intracranial_spinal_surgery

Numeric (0 or 1). Recent intracranial or spinal surgery (within 3 months). (1 = Yes).

active_internal_bleeding

Numeric (0 or 1). Active internal bleeding. (1 = Yes).

suspected_aortic_dissection

Numeric (0 or 1). Clinical suspicion of aortic dissection. (1 = Yes).

severe_uncontrolled_hypertension

Numeric (0 or 1). Severe uncontrolled hypertension (SBP > 185 or DBP > 110) unresponsive to treatment. (1 = Yes).

recent_stroke

Numeric (0 or 1). Recent ischemic stroke (within 3 months). (1 = Yes).

recent_head_trauma

Numeric (0 or 1). Recent significant head trauma (within 3 months). (1 = Yes).

current_anticoagulant_use

Numeric (0 or 1). Current use of anticoagulant medication (e.g., warfarin, DOACs). (1 = Yes).

platelet_count

Numeric. Platelet count in /mm^3. (< 100,000 is a contraindication).

inr

Numeric. International Normalized Ratio. (> 1.7 is a contraindication).

aptt

Numeric. Activated Partial Thromboplastin Time in seconds. (Elevated aPTT in heparin users is a contraindication).

pt

Numeric. Prothrombin Time in seconds. (> 15s is a contraindication).

glucose

Numeric. Blood glucose level in mg/dL. (< 50 mg/dL is a contraindication).

References

Powers WJ, et al. 2018 Guidelines for the Early Management of Patients With Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke. 2018.

Examples

# Example 1: Contraindicated (Time window)
# 5 hours duration, otherwise normal
check_tpa_contraindications(5, 65, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 250000, 1.0, 30, 12, 100)

# Example 2: Contraindicated (History of ICH)
# 2 hours, Hx ICH
check_tpa_contraindications(2, 70, 0, 1, 0, 0, 0, 0, 0, 0, 0, 0, 200000, 1.0, 30, 12, 90)

# Example 3: Indicated
# 2 hours, No contraindications
check_tpa_contraindications(2, 60, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 200000, 1.0, 30, 12, 100)