Which of the following is a high-risk contraindication to tPA beyond standard criteria?

• A. Recent intracranial surgery or head trauma
• B. Diabetes mellitus
• C. Mild hypertension
• D. Current aspirin use

Answer: (A)

This item tests recognizing a high-risk contraindication to IV thrombolysis for acute ischemic stroke. Giving tPA helps dissolve clots but markedly increases the risk of bleeding, especially inside the skull. Recent intracranial surgery or head trauma indicates a recently injured brain with surgical or tissue disruption, making bleeding into the brain far more likely if a clot-dissolving drug is given. That’s why this scenario is treated as a high-risk contraindication beyond standard criteria.

Diabetes mellitus is a vascular risk factor but not an absolute exclusion for tPA beyond standard rules. Mild hypertension is typically controlled within the allowed blood pressure range for tPA administration, so it isn’t a high-risk contraindication on its own. Current aspirin use is not an automatic disqualifier; antiplatelet therapy can often be managed with tPA under current guidelines, depending on the dose and timing.