A Case of Acute Ischemic Stroke Treated With Alteplase Immediately After Transcatheter Aortic Valve Implantation: Which Procedures or Surgeries are Considered Contraindications to Thrombolytics?

Undergoing a major surgery within 14 days is considered a contraindication for intravenous alteplase. However, there is no consensus as to what qualifies as major surgery or an invasive procedure. Occasionally, determining whether a procedure is "invasive" or too risky in the setting of emergency ischemic stroke thrombolytic management can be challenging. Stroke neurologists may not be able to make such a decision on their own. Guidance or clearance from the physicians who performed the procedure is essential. We report the case of a patient who received intravenous alteplase after developing a stroke immediately following transcatheter aortic valve implantation (TAVI).