Table 6

Contraindications and Cautions for Fibrinolytic Therapy in STEMI

Absolute contraindications
 • Any prior ICH
 • Known structural cerebral vascular lesion (e.g., 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
 • Major surgery (<3 wk)
 • Recent (within 2 to 4 wk) internal bleeding
 • Noncompressible vascular punctures
 • Pregnancy
 • Active peptic ulcer
 • Oral anticoagulant therapy

CPR indicates cardiopulmonary resuscitation; DBP; diastolic blood pressure; ICH, intracranial hemorrhage; SBP, systolic blood pressure; and STEMI, ST-elevation myocardial infarction.

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