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.