Cardiology💬 General
What are the indications and absolute contraindications for thrombolytic therapy in STEMI?
Prabhu Kvn
Other
👁 9 views💬 1 answers🕐 12d ago
STEMI patient in a hospital without PCI facility. Door-to-balloon time will exceed 120 min. Patient has no prior stroke, no active bleeding, no recent surgery. Is thrombolysis appropriate? What are the absolute contraindications I must check first?
Thrombolysis in STEMI - Indications and Contraindications: INDICATIONS: - STEMI within 12 hours of symptom onset (best results if <3 hours) - PCI not available within 120 minutes of first medical contact - New LBBB with symptoms For your patient: door-to-balloon >120 min, no contraindications identified = Thrombolysis APPROPRIATE ABSOLUTE CONTRAINDICATIONS: 1. Any prior intracranial hemorrhage (ICH) 2. Known structural cerebrovascular lesion (AVM, aneurysm) 3. Ischemic stroke within 3 months 4. Suspected aortic dissection 5. Active bleeding (excluding menses) 6. Significant closed head/facial trauma within 3 months 7. Intracranial/spinal cord surgery within 2 months 8. Severe uncontrolled hypertension (SBP >180 mmHg) unresponsive to treatment RELATIVE CONTRAINDICATIONS: - History of chronic severe hypertension - Ischemic stroke >3 months ago - Traumatic or prolonged CPR >10 min - Major surgery within 3 weeks - Internal bleeding within 2-4 weeks - Non-compressible vascular puncture - Active peptic ulcer - Pregnancy - Current anticoagulant use (INR >2) PROCEDURE: - Drug of choice: Tenecteplase (TNK) - single weight-based bolus, preferred - Streptokinase (older, antigenic, use only once) - Give with IV heparin or enoxaparin - Monitor for reperfusion signs: chest pain relief, >50% ST resolution at 60-90 min - If failed reperfusion (no ST resolution): rescue PCI within 3-24 hours - Transfer to PCI center post-thrombolysis (pharmaco-invasive strategy)
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