What is a contraindication for the use of tPA in a patient post-cerebrovascular accident (CVA)?

• A. Prior stroke within one month
• B. CVA more than two months ago
• C. Severe hypertension
• D. Patient age over 80

Answer: (A)

The appropriate contraindication for the use of tPA (tissue plasminogen activator) in a patient post-cerebrovascular accident (CVA) is having a prior stroke within one month. This is critical because administering tPA in someone with a recent stroke poses a significant risk for potential complications, particularly the risk of hemorrhagic transformation, where an ischemic stroke can turn into a bleeding stroke.

tPA is intended for the treatment of acute ischemic strokes but is strictly contraindicated in certain situations where the risk of bleeding outweighs the benefits. A previous stroke within a short timeframe, such as one month, indicates that the patient's cerebral tissue may still be at risk from a previous injury. Therefore, administering tPA could exacerbate the situation, leading to potentially life-threatening outcomes.

In contrast, factors such as having experienced a CVA more than two months ago may not preclude tPA use, as the risk factors associated with a prior stroke diminish over time. Severe hypertension is indeed a relative contraindication, but it could often be managed or corrected prior to administering tPA. Patient age over 80 can increase the risk of complications but is not a strict contraindication on its own; treatment decisions can involve other clinical judgments.