Thrombolytics can be used to treat different diseases, such as ischemic strokes (<3-4.5 hours), myocardial infarctions with ST elevation (<12 hours), DVTs (risk of limb loss) and pulmonary embolism (unstable patients). However, many contraindications exist for this treatment due to the high bleeding risk. Some of the most important contraindications for thrombolytics include:
Absolute contraindications:
Prior intracranial hemorrhage (any time)
Malignant intracranial tumor
Intracranial structural cerebral vascular lesion
Ischemic stroke within 3 months (exception for acute stroke within 3 hours)
Active bleeding or bleeding diathesis
Significant head or facial trauma within 3 months
Suspected aortic dissection
Relative contraindications:
Severe uncontrolled hypertension (SBP > 180 mmHG or DBP >110 mmHg)
Nonhemorrhagic stroke >3 months
Major surgery < 3 weeks
Traumatic or Prolonged CPR (> 10 minutes)
Active peptic ulcer
Pregnancy
Noncompressible vascular punctures or Recent invasive procedure
For streptokinase/anistreplase – Prior exposure (more than five days ago) or prior allergic reaction to these agents
Recent internal bleeding (2 to 4 weeks)
Current use of anticoagulant
These indications should be considered both for IV thrombolytics or for catheter directed thrombolysis. It is needless to say that every case should be evaluated individually.
SOURCES & FURTHER READING:
- Grzybowski M et al. Mortality Benefit of Immediate Revascularization of Acute ST-Segment Elevation Myocardial Infarction in Patients With Contraindications to Thrombolytic TherapyA Propensity Analysis. JAMA. 2003;290(14):1891-1898.
- Kearon C et al. Antithrombotic Therapy for VTE Disease: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012;141(2_suppl):e419S-e494S.
- Fibrinolytic CHecklist for STEMI. ACLS Training Center.