American Board of Internal Medicine (ABIM) Certification Practice Exam

What is an absolute contraindication for tPA treatment?

1. Active peptic ulcer disease

2. History of hyperlipidemia

3. Previous intracerebral hemorrhage

4. Pregnancy

The correct answer is: Previous intracerebral hemorrhage

The identification of a previous intracerebral hemorrhage as an absolute contraindication for tissue plasminogen activator (tPA) treatment is critical in the management of acute ischemic stroke. tPA is a thrombolytic agent that works by dissolving blood clots that obstruct blood flow to the brain. However, its use carries the risk of causing further bleeding, particularly in patients with a history of cerebral hemorrhage. A prior episode of intracerebral hemorrhage significantly raises the risk of recurrent bleeding if tPA is administered. Because the goal of treatment is to minimize potential harm and maximize benefit, previous intracerebral hemorrhage is a definitive factor that excludes a patient from receiving tPA, regardless of other clinical considerations. In contrast, while active peptic ulcer disease may increase bleeding risk, it is not considered an absolute contraindication. History of hyperlipidemia typically does not influence decisions about tPA treatment directly. Furthermore, pregnancy is a condition that requires careful consideration, but it is not classified as an absolute contraindication for tPA; rather, it necessitates a risk-benefit analysis based on individual circumstances. Thus, the history of intracerebral hemorrhage remains critical in guiding safe treatment practices for patients with acute ischemic stroke