American Board of Internal Medicine (ABIM) Certification Practice Exam

In the administration of tPA, what does a history of any anticoagulant use indicate?

1. Increased efficacy of treatment

2. Prolonged treatment duration

3. Exclusion from treatment

4. Improved outcomes

The correct answer is: Exclusion from treatment

A history of any anticoagulant use indicates exclusion from treatment with tPA (tissue plasminogen activator) due to the significant risk of bleeding complications. tPA is a thrombolytic agent used primarily in the treatment of acute ischemic stroke, and its administration can lead to hemorrhagic transformation, especially in patients who have been anticoagulated. The presence of anticoagulants in a patient's system exacerbates the risk of severe bleeding, which can be life-threatening. Therefore, guidelines generally stipulate that patients who have recently used anticoagulants, or who have indications of anticoagulation therapy, should be carefully evaluated to determine whether the risks outweigh the benefits of tPA treatment. In this context, other factors, such as improved outcomes, prolonged treatment duration, or increased efficacy of treatment, do not pertain to patients with a history of anticoagulant use. For these reasons, patients with such a history are typically excluded from receiving tPA. This focus on safety underscores the importance of careful patient selection in the administration of thrombolytic therapy.