Which combination represents two major contraindications to IV alteplase in acute ischemic stroke?

Which combination represents two major contraindications to IV alteplase in acute ischemic stroke?

• A. Hypertension and hyperglycemia
• B. Age over 85 and prior stroke
• C. Recent surgery and pregnancy
• D. Active intracranial hemorrhage on imaging and markedly reduced platelets or elevated INR

Answer: (D)

The key idea is understanding when IV alteplase cannot be given because the risk of bleeding far outweighs the benefit. Two absolute contraindications to thrombolysis in acute ischemic stroke are present here: active intracranial hemorrhage on brain imaging and a coagulation problem that makes bleeding more likely, such as markedly reduced platelets or an elevated INR. If imaging already shows a bleed inside the skull, administering a strong clot-buster would almost surely worsen that bleed and cause devastating harm. Likewise, a very low platelet count or a high INR means the blood doesn’t clot well, so giving alteplase could lead to uncontrolled bleeding. The other options involve risk factors or situations that may influence decisions or require caution, but they do not by themselves constitute two clear, absolute contraindications.

The key idea is understanding when IV alteplase cannot be given because the risk of bleeding far outweighs the benefit. Two absolute contraindications to thrombolysis in acute ischemic stroke are present here: active intracranial hemorrhage on brain imaging and a coagulation problem that makes bleeding more likely, such as markedly reduced platelets or an elevated INR. If imaging already shows a bleed inside the skull, administering a strong clot-buster would almost surely worsen that bleed and cause devastating harm. Likewise, a very low platelet count or a high INR means the blood doesn’t clot well, so giving alteplase could lead to uncontrolled bleeding. The other options involve risk factors or situations that may influence decisions or require caution, but they do not by themselves constitute two clear, absolute contraindications.