Q: I recently attended a class on acute stroke. One of the therapies, of course, is tPA. I am wondering why previous stroke and acute myocardial infarction (both less than 3 months earlier) are contraindications? Also why is history of either stroke or diabetes a concern when giving tPA?

A: Anne W. Alexandrov, RN, PhD, CCRN, replies:

Tissue plasminogen activator (tPA) was approved by the US Food and Drug Administration in May 1996. The approval was based on the results of the National Institutes of Neurologic Disorders (NINDS) tPA study,1  which showed significant benefit to ischemic stroke patients who received this drug within 3 hours of symptom onset. The prescribing information that was later approved by the Food and Drug Administration was based on the methods used in that trial.

The concern about patients who have had a stroke within 3 months of a new stroke event relates to...

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