Contraindications and cautions for fibrinolysis in STEMI

Associate Editor:

Absolute contraindications to thrombolysis

 * 1) Any prior ICH
 * 2) Known structural cerebrovascular lesion (e.g., arteriovenous malformation)
 * 3) Known malignant intracranial neoplasm (primary or metastatic)
 * 4) Ischemic stroke within 3 months except acute ischemic stroke within 3 hours
 * 5) Suspected aortic dissection
 * 6) Active bleeding or bleeding diathesis (except menses)

Relative contraindications to thrombolysis

 * 1) History of chronic, severe, poorly controlled hypertension
 * 2) Severe uncontrolled hypertension on presentation (systolic blood pressure >180 mm Hg or diastolic blood pressure >110 mm Hg)
 * 3) Traumatic or prolonged (>10 min) cardiopulmonary resuscitation or major surgery (within <3 weeks)
 * 4) Recent (within 2 to 4 weeks) internal bleeding
 * 5) Non compressible vascular punctures
 * 6) For streptokinase/anistreplase: prior exposure (>5 days) or prior allergic reaction to these agents
 * 7) Pregnancy
 * 8) Active peptic ulcer
 * 9) History of prior ischemic stroke (>3 months), dementia, or known intracranial pathology not covered in absolute contraindications
 * 10) Current use of anticoagulants: the higher the INR, the higher the risk of bleeding