Answer and Explanation 25

25.  Choice A is the correct answer.  The patient meets numerous exclusion criteria for TPA.  His stroke scale is high enough but he has a INR greater than 1.7 and is on coumadin which is an exclusion criteria.  Other exclusion criteria include evidence of intracranial hemorrhage, improving symptoms, active internal bleeding in the last 21 days or bleeding risk, Platelet count less than 100,000, heparin in the last 48 hours with an elevated PTT, major surgery in the last 14 days, serious head trauma or intracranial surgery in the preceding 3 months, recent arterial puncture at non compressible site, recent lumbar puncture in the last 7 days, SBP> 185 or DBP >110 mmHg, recent seizure, recent MI, recent TIA, or history of ICH, neoplasm, AV malformation, or aneurysm.