Fibrinolytic Therapy

Contraindications and cautions for fibrinolytic use in STEMI from ACC/AHA 2004 Guideline Update*
Absolute Contraindications

  • Any prior intracranial hemorrhage

  • Known structural cerebral vascular lesion (eg, AVM)

  • 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 (excluding menses)

  • Significant closed head trauma or facial trauma within 3 months

Relative Contraindications

  • History of chronic, severe, poorly controlled hypertension

  • Severe uncontrolled hypertension on presentation (SBP >180 mm Hg or DBP >110 mm Hg)

  • History of prior ischemic stroke >3 months, dementia, or known intracranial pathology not covered in contraindications

  • Traumatic or prolonged (>10 minutes) CPR or major surgery (<3 weeks)

  • Recent (within 2 to 4 weeks) internal bleeding

  • Noncompressible vascular punctures

  • For streptokinase/anistreplase: prior exposure (>5 days ago) or prior allergic reaction to these agents

  • Pregnancy

  • Active peptic ulcer

  • Current use of anticoagulants: the higher the INR, the higher the risk of bleeding

  • CPR, cardiopulmonary resuscitation; AVM indicates arteriovenous malformation; SBP, systolic blood pressure; DBP, diastolic
    blood pressure; INR, International Normalized Ratio.

  • * Viewed as advisory for clinical decision making and may not be all-inclusive or definitive.

  • Could be an absolute contraindication in low-risk patients with myocardial infarction.