Private: Management of STEMI and its Complications

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Contraindications

The main hazard of thrombolysis is haemorrhage and, in particular, intracranial haemorrhage. There is an excess of 3.9 cerebral events per 1000 patients treated [7], the risk being maximal during the 24 hours immediately following thrombolysis. Specific risk factors for intracranial haemorrhage include female gender, advanced age, low body weight and elevated blood pressure at presentation.

Contra-indications

Table 1 lists the conventional contra-indications to thrombolysis. Advanced age is not, in itself, a contra-indication to thrombolysis. Whilst there is an increased risk of intracranial haemorrhage associated with thrombolysis in the elderly, overall mortality is significantly reduced by thrombolytic therapy in patients over the age of 75 years who present within 12 hours of onset of symptoms [11].

Table 1: Contra-indications to thrombolysis

Absolute Contraindications
  • Haemorrhagic stroke at any time
  • Ischaemic stroke within 6 months
  • Recent major surgery (within 3 weeks)
  • Recent major trauma / head injury (within 3 weeks)
  • Recent gastro-intestinal bleeding (within 1 month)
  • Aortic dissection
  • Known bleeding disorder
  • Neurological deficit or CNS neoplasm

Relative Contraindications
  • ??Warfarin therapy (check INR)
  • Pregnancy or immediate post-partum period
  • Transient ischaemic attack in preceding 6 months
  • Prolonged or traumatic resuscitation
  • Systolic blood pressure >180mmHg
  • Active peptic ulcer, advanced hepatic disease
  • Non-compressible puncture site
  • Infective endocarditis

Learning Bite

Advanced age, in itself, is not a contra-indication to thrombolysis.