nontPA

NontPA stands for non-tissue plasminogen activator and refers to therapeutic approaches for thromboembolic disease that do not involve the tissue plasminogen activator enzyme. In the context of acute ischemic stroke, tPA is a commonly used reperfusion therapy when administered within a defined time window and in patients without contraindications. NontPA strategies are important when tPA is contraindicated, unavailable, or when additional reperfusion is sought.

The principal nontPA reperfusion method is mechanical thrombectomy, an endovascular procedure that physically removes or traps clots from intracranial arteries using specialized devices. Mechanical thrombectomy has shown benefit for patients with large vessel occlusions and, with appropriate selection based on imaging, can be pursued in extended time windows in eligible cases.

Other pharmacologic options that do not involve tPA include older non-tPA thrombolytics such as streptokinase or urokinase. These agents are less commonly used in many contemporary stroke protocols due to bleeding risk, variable efficacy, and evolving evidence favoring mechanical thrombectomy for suitable patients.

Beyond reperfusion, nontPA management encompasses antiplatelet therapy (for patients not treated with reperfusion or for secondary prevention), anticoagulation where indicated (for example, cardioembolic sources such as atrial fibrillation), and general supportive care including blood pressure and glucose control.

In practice, the term “nontPA” is used to distinguish reperfusion strategies that do not rely on tissue plasminogen activator from tPA-based approaches, highlighting the role of endovascular and other non-pharmacologic options in thromboembolic care.