CRITERIA FOR THROMBOLYSIS:
- Ischemic chest pain of at least 15 minutes duration, and unrelieved with sublingual nitroglycerine (2 times).
- 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.
- 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.
