Contraindications and cautions for fibrinolytic use in STEMI from ACC/AHA 2004 Guideline Update* |
Absolute Contraindications
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Any prior intracranial hemorrhage
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Known structural cerebral vascular lesion (eg, AVM)
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Known malignant intracranial neoplasm (primary or metastatic)
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Ischemic stroke within 3 months EXCEPT acute ischemic stroke within 3 hours
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Suspected aortic dissection
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Active bleeding or bleeding diathesis (excluding menses)
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Significant closed head trauma or facial trauma within 3 months
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Relative Contraindications
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History of chronic, severe, poorly controlled hypertension
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Severe uncontrolled hypertension on presentation (SBP >180 mm Hg or DBP >110 mm Hg)†
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History of prior ischemic stroke >3 months, dementia, or known intracranial pathology not covered in contraindications
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Traumatic or prolonged (>10 minutes) CPR or major surgery (<3 weeks)
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Recent (within 2 to 4 weeks) internal bleeding
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Noncompressible vascular punctures
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For streptokinase/anistreplase: prior exposure (>5 days ago) or prior allergic reaction to these agents
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Pregnancy
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Active peptic ulcer
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Current use of anticoagulants: the higher the INR, the higher the risk of bleeding
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