Table 1.

Contraindications and cautions for thrombolysis in STEMI

Absolute contraindications
Any prior intracerebral hemorrhage
Known structural cerebral vascular lesion (eg, arteriovenous malformation)
Known malignant intracranial neoplasm (primary or metastatic)
Ischemic stroke within 3 months EXCEPT acute ischemic stroke within 3 hours
Suspected aortic dissection
Active bleeding or bleeding diathesis (excluding menses)
Significant closed-head or facial trauma within 3 months
Relative contraindications:
History of chronic, severe, poorly controlled hypertension
Severe uncontrolled hypertension on presentation (SBP greater than 180 mmHg or DBP greater than 110 mmHg)†
History of prior ischemic stroke greater than 3 months, dementia, or known intracranial pathology not covered in contraindications
Traumatic or prolonged (greater than 10 minutes) CPR or major surgery (less than 3 weeks)
Recent (within 2–4 weeks) internal bleeding
Noncompressible vascular punctures
For streptokinase/anistreplase: prior exposure (more than 5 days) or prior allergic reaction to these agents
Pregnancy
Active peptic ulcer
Current use of anticoagulants: the higher the INR, the higher the risk of bleeding

Abbreviations: ICH, intracranial hemorrhage; SBP, systolic blood pressure; DBP, diastolic blood pressure; CPR, cardiopulmonary resuscitation; INR, international normalized ratio; MI, myocardial infarction.

Adapted with permission from Antman EM, Anbe DT, Armstrong PW, et al. ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction: executive summary: a report of the ACC/AHA Task Force on Practice Guidelines (Committee to Revise the 1999 Guidelines for the Management of Patients With Acute Myocardial Infarction). J Am Coll Cardiol. 2004;44:671–719.² Copyright © 2004 Elsevier.