Contraindications to Fibrinolytic Therapy in Patients with STEMI
Contraindications to Fibrinolytic Therapy in Patients with STEMI
Absolute Contraindications:
- Any prior intracranial hemorrhage
- Known structural cerebral vascular lesion
- Known intracranial neoplasm (primary or metastatic)
- Ischemic stroke within the past 3 months (except for acute stroke within 4.5 hours)
- Suspected aortic dissection
- Active bleeding or bleeding diathesis (excluding menses)
- Significant closed-head or facial trauma within 3 months
- Intracranial or intraspinal surgery within 2 months
- Severe uncontrolled hypertension (unresponsive to emergency therapy)
- For streptokinase (no longer marketed in the US): Prior treatment within previous 6 months
Relative Contraindications:
- History of chronic, severe, poorly controlled hypertension
- Systolic pressure >180 mm Hg or diastolic pressure >110 mm Hg
- History of prior ischemic stroke >3 months
- Dementia
- Known intracranial pathology not covered in absolute contraindications
- Traumatic or prolonged CPR (>10 minutes)
- Recent (within 2-4 weeks) internal bleeding
- Noncompressible vascular punctures
- Pregnancy
- Active peptic ulcer disease
- Current use of anticoagulants: The higher the INR, the higher the risk of bleeding
- For streptokinase (no longer marketed in the US): Prior exposure (>5 days previously) or prior allergic reaction to these agents
CPR = cardiopulmonary resuscitation; INR = international normalized ratio; STEMI = ST-elevation myocardial infarction; US = United States of America.
Table modified from 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines.
