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Stroke »

What is a stroke?

Brain cell function requires a constant delivery of oxygen and glucose from the bloodstream. A stroke, or cerebrovascular accident (CVA), occurs when blood supply to part of the brain is disrupted, causing brain cells to die. Blood flow can be compromised by a variety of mechanisms.

Blockage of an artery

  • Narrowing of the small arteries within the brain can cause a lacunar stroke, (lacune means "empty space"). Blockage of a single arteriole can affect a tiny area of brain causing that tissue to die (infarct).
  • Hardening of the arteries (atherosclerosis) leading to the brain. There are four major blood vessels that supply the brain with blood. The anterior circulation of the brain that controls most motor  activity, sensation, thought, speech, and emotion is supplied by the carotid arteries. The posterior circulation, which supplies the brainstem and the cer...

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Activase

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OVERDOSE

No information provided.

CONTRAINDICATIONS

Acute Myocardial Infarction or Pulmonary Embolism

Activase (alteplase) therapy in patients with acute myocardial infarction or pulmonary embolism is contraindicated in the following situations because of an increased risk of bleeding:

  •    Active internal bleeding
  •     History of cerebrovascular accident
  •     Recent intracranial or intraspinal surgery or trauma (see WARNINGS)
  •     Intracranial neoplasm, arteriovenous malformation, or aneurysm
  •     Known bleeding diathesis
  •     Severe uncontrolled hypertension

Acute Ischemic Stroke

Activase (alteplase) therapy in patients with acute ischemic stroke is contraindicated in the following situations because of an increased risk of bleeding, which could result in significant disability or death:

  •     Evidence of intracranial hemorrhage on pretreatment evaluation
  •     Suspicion of subarachnoid hemorrhage on pretreatment evaluation
  •     Recent (within 3 months) intracranial or intraspinal surgery, serious head trauma, or previous stroke
  •     History of intracranial hemorrhage
  •     Uncontrolled hypertension at time of treatment (e.g., > 185 mm Hg systolic or > 110 mm Hg diastolic)
  •     Seizure at the onset of stroke
  •     Active internal bleeding
  •     Intracranial neoplasm, arteriovenous malformation, or aneurysm
  •     Known bleeding diathesis including but not limited to:

-  Current use of oral anticoagulants (e.g., warfarin sodium) or an International Normalized Ratio (INR) > 1.7 or a prothrombin time (PT) > 15 seconds
- Administration of heparin within 48 hours preceding the onset of stroke and have an elevated activated partial thromboplastin time (aPTT) at presentation
-  Platelet count < 100,000/mm3

REFERENCES

14. Aylward P, Wilcox R, Horgan J, White H, Granger C, Califf R, et al. for the GUSTO-I Investigators. Relation of increased arterial blood pressure to mortality and stroke in the context of contemporary thrombolytic therapy for acute myocardial infarction: a randomized trial. Ann Int Med. 1996;125:891-900.

Last reviewed on RxList: 5/9/2008
This monograph has been modified to include the generic and brand name in many instances.

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