|• Previous hemorrhagic stroke at any time, other strokes or cerebrovascular events within 1 year|
|• Known intracranial neoplasm|
|• Active internal bleeding (does not include menses)|
|• Suspected aortic dissection|
|• Severe uncontrolled hypertension on presentation (blood pressure >180/110 mm Hg)†|
|• History of prior cerebrovascular accident or known intracerebral pathology not covered in contraindications|
|• Current use of anticoagulants in therapeutic doses (INR ≥2–3); known bleeding diathesis|
|• Recent trauma (within 2–4 weeks) including head trauma or traumatic or prolonged (>10 min) CPR or major surgery (3 weeks)|
|• Noncompressible vascular punctures|
|• Recent (within 2 to 4 weeks) internal bleeding|
|• For streptokinase/anistreplase: prior exposure (especially within 5 days–2 years) or prior allergic reaction|
|• Active peptic ulcer|
|• History of chronic severe hypertension|
↵∗ 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.
↵legend INR = International Normalized Ratio; CPR = cardiopulmonary resuscitation.
legend Reproduced with permission from Ryan TJ, Antman EM, Brooks NH, et al. ACC/AHA guidelines for the management of patients with acute myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Acute Myocardial Infarction). J Am Coll Cardiol 1999;34:890–911.