Contraindications to thrombolysis in Myocardial infarction
Fibrinolytic agents should be given with 30 minutes of arrival to non-PCI capable hospital where transport to PCI capable hospital is not possible or has delay beyond 120 minutes
Current recommended regimen is tPA 15 mg bolus followed by 50 mg Intravenously over 30 minutes and 35 mg over the next 30 minutes. In contrast tenecteplase can be given as weight based intravenous bolus over 10 seconds.
Clear Contraindications are remembered by mnemonic: HAS-BLEED
| 1. Hypertension marked elevation of BP > 180/110 mm Hg at any time during presentation 2. Aortic dissection suspected 3. Stroke: Hemorrhagic at any time 4. Stroke: Non-hemorrhagic in last 1 year 5. Bleeding (active internal bleed excluding menses) |
Relative contraindications to fibrinolytic therapy
Mnemonic: RIP – AB
AB implies has allergy or Bleed in eye/GIT or bleed risk due to hypertension
| Recent invasive surgical procedure in last 2 weeks INR> 2 due to current use of OAC Prolonged CPR (> 10 minutes) Pregnancy Risk of Allergic reaction with received STK within preceding 5 days to 2 years Hemorrhagic diabetic retinopathy Active Peptic ulcer disease Severe Hypertension |
Hemorrhage is the most serious and most frequent complication of thrombolysis. Hemorrhagic stroke can occur in 0.5 to 0.9% of patients treated with fibrinolytic agents