Contraindications and cautions for fibrinolysis in STEMI
Jump to navigation
Jump to search
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Associate Editor: Cafer Zorkun, M.D., Ph.D. [2]
Absolute contraindications to thrombolysis
- Any prior ICH
- Known structural cerebrovascular lesion (e.g., arteriovenous malformation)
- Known malignant intracranial neoplasm (primary or metastatic)
- Ischemic stroke within 3 months except acute ischemic stroke within 3 hours
- Suspected aortic dissection
- Active bleeding or bleeding diathesis (except menses)
Relative contraindications to thrombolysis
- History of chronic, severe, poorly controlled hypertension
- Severe uncontrolled hypertension on presentation (systolic blood pressure >180 mm Hg or diastolic blood pressure >110 mm Hg)
- Traumatic or prolonged (>10 min) cardiopulmonary resuscitation or major surgery (within <3 weeks)
- Recent (within 2 to 4 weeks) internal bleeding
- Non compressible vascular punctures
- For streptokinase/anistreplase: prior exposure (>5 days) or prior allergic reaction to these agents
- Pregnancy
- Active peptic ulcer
- History of prior ischemic stroke (>3 months), dementia, or known intracranial pathology not covered in absolute contraindications
- Current use of anticoagulants: the higher the INR, the higher the risk of bleeding