American Board of Internal Medicine (ABIM) Certification Practice Exam

Which of these is a relative contraindication for tPA treatment?

1. Recent internal bleeding within 2-4 weeks

2. History of stable hypertension

3. Treatment with anticoagulants for over 6 months

4. Pneumonia history

The correct answer is: Recent internal bleeding within 2-4 weeks

The identification of recent internal bleeding within 2-4 weeks as a relative contraindication for the administration of tissue plasminogen activator (tPA) treatment is founded on the significant risk of further bleeding. tPA is a thrombolytic agent used primarily in the management of acute ischemic stroke. Given its mechanism of action, which involves dissolving existing clots, a patient with a recent bleeding event is at a heightened risk for more severe hemorrhagic complications. The time frame, specifically 2-4 weeks, is critical because it indicates a recent event that could still pose a risk, where the patient's hemostatic mechanisms may still be compromised. In contrast, a history of stable hypertension generally does not pose as significant a risk if the condition is well-managed and controlled. Treatment with anticoagulants for over six months can raise concerns, but it does not automatically constitute a relative contraindication unless there are other underlying factors. Lastly, a history of pneumonia does not inherently increase the risk of bleeding when administering tPA, and thus, does not qualify as a contraindication. Understanding these distinctions is crucial for clinical decision-making concerning tPA treatment in acute ischemic stroke scenarios.