Treatment
Table 6. Contraindications and Cautions for Fibrinolytic
Therapy in STEMIa
Absolute contraindications
Any prior intracranial hemorrhage (ICH)
Known structural cerebral vascular lesion (eg, arteriovenous malformation)
Known malignant intracranial neoplasm (primary or metastatic)
Ischemic stroke within 3 mo
• EXCEPT acute ischemic stroke within 4.5 h
Suspected aortic dissection
Active bleeding or bleeding diathesis (excluding menses)
Significant closed-head or facial trauma within 3 mo
Intracranial or intraspinal surgery within 2 mo
Severe uncontrolled hypertension (unresponsive to emergency therapy)
For streptokinase, prior treatment within the previous 6 mo
Relative contraindications
History of chronic, severe, poorly controlled hypertension
Significant hypertension on presentation (SBP >180 mm Hg or DBP >110 mm Hg)
History of prior ischemic stroke >3 mo
Dementia
Known intracranial pathology not covered in absolute contraindications
Traumatic or prolonged (>10 min) CPR
Recent major surgery (<3 wk)
Recent (within 2-4 wk) internal bleeding
Noncompressible vascular punctures
Pregnancy
Active peptic ulcer
Oral anticoagulant therapy
CPR, cardiopulmonary resuscitation, DBP, diastolic blood pressure; SBP, systolic blood
pressure
a
10
Viewed as advisory for clinical decision making and may not be all-inclusive or definitive.
