Intravenous Thrombolytic Therapy

CRITERIA FOR THROMBOLYSIS:

  1. Ischemic chest pain of at least 15 minutes duration, and unrelieved with sublingual nitroglycerine (2 times).
  2. ECG evidence of Acute Myocardial Infarction (1- 2 mm ST segment elevation in two contiguous leads or new onset of complete left bundle branch block.
  3. Thrombolytic therapy should be given within 12 hours (preferably < 4 hours) of onset of chest pain that is consistent with myocardial infarction .In case of recurrence or persistence  of chest pain the period can be extended to 24 hours.

ABSOLUTE CONTRAINDICATIONS:

  • Any prior intra — cranial hemorrhage.
  • Known structural cerebral vascular lesion (e.g. arterio-venous malformation).
  • Known malignant intra — cranial 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.
  • Acute pericarditis.
  • Esophageal varices.
  • Recent major surgery (within < 3 weeks).

RELATIVE CONTRAINDICATIONS:

  • History of chronic severe poorly controlled hypertension.
  • Severe uncontrolled hypertension on presentation (SBP > 180; DBP > 110 Hg).
  • 3 History of prior ischemic stroke > 3 months, dementia or known intra cranial pathology not covered in contraindications.
  • Traumatic or prolonged (> 10 minutes) cardio — pulmonary resuscitation (CPR) or major surgery (> 3 weeks).
  • Recent (within 2-4 weeks) internal bleeding.
  • Non – compressible vascular punctures.
  • For Streptokinase / Anistreplase; prior exposure (more than 5 days ago) or prior allergic reaction to these agents.
  • Pregnancy
  • Active peptic ulcer.
  • Active peptic ulcer.
  • Current use of anticoagulants; the higher the INR, the risk of bleeding.
  • Potent hemorrhagic focus:
    • Within 6 months of GI hemorrhage or CVA (Stroke).
    • Within 2-4 weeks of
      • Organ biopsy
      • Major trauma
      • Minor head trauma
    • Proliferative diabetic retinopathy.
    • History of bleeding diathesis, hepatic dysfunction and / or malignancy.
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