Which of the following is a contraindication to tissue plasminogen activator (TPA) therapy?

• A. Previous intracranial hemorrhage
• B. Controlled diabetes mellitus
• C. Recent uncomplicated dental procedure
• D. Chronic stable hypertension

Answer: (A)

tPA dissolves clots, which helps restore blood flow in an ischemic stroke, but it also raises the risk of bleeding throughout the body, including in the brain. A history of intracranial hemorrhage means the brain has bled before and its vessels may be fragile; giving a powerful clot-dissolving agent can provoke a dangerous rebleed or expansion of that prior bleed, making it an absolute contraindication.

The other situations do not by themselves rule out tPA. Diabetes that is well controlled does not create an insurmountable bleeding risk, and a recent uncomplicated dental procedure isn’t an absolute barrier to therapy. Chronic stable hypertension isn’t an automatic contraindication either, provided blood pressure can be lowered to safe levels (generally below 185/110 mmHg) before giving tPA.