What are contraindications to fibrinolytic therapy in a CV event?

Relative contraindications

• Severe hypertension or uncontrolled hypertension (blood pressure >180 mm Hg systolic and/or >110 mm Hg diastolic.
• Ischemic stroke longer than three months ago.
• Dementia.
• Any known intracranial disease that is not an absolute contraindication.

Who is not a candidate for fibrinolytic therapy?

Patients who have uncontrolled hypertension with a systolic blood pressure of greater than 180 mm Hg or a diastolic of greater than 110 mm Hg may also be excluded. Blood glucose levels are also taken into consideration. A glucose concentration of less than 50 mg/dL is considered a contraindication.

Why TPA is contraindicated in MI?

Thrombolytic therapy is contraindicated in patients with known pregnancy, active internal bleeding, uncontrolled hypertension, aortic dissection, intracranial neoplasm or a history of hemorrhagic stroke.

What are contraindications for thrombolytic therapy?

Absolute Contraindications for Thrombolytic Treatment

• Recent intracranial hemorrhage (ICH)
• Structural cerebral vascular lesion.
• Intracranial neoplasm.
• Ischemic stroke within three months.
• Possible aortic dissection.
• Active bleeding or bleeding diathesis (excluding menses)

What are the contraindications for beginning fibrinolytic therapy?

Contraindications

• Prior intracranial hemorrhage.
• Ischemic stroke within 3 months.
• Known cerebrovascular abnormality such as aneurysm or arteriovenous malformation.
• Known malignant intracranial tumor.
• Significant closed-head trauma or facial trauma within 3 months.

Is fibrinolytic therapy as effective as Ppci?

Mechanical revascularization, or primary percutaneous coronary intervention (PPCI), of the infarct artery is the preferred method of restoring coronary perfusion because of its superior efficacy and decreased risk of complications compared with fibrinolytic therapy.

What is the criteria for fibrinolytic therapy?

Systolic blood pressure under 185 mm Hg, diastolic blood pressure under 110 mm Hg. No evidence of acute trauma or bleeding. Not taking an oral anticoagulant, or if so, international normalized ratio (INR) under 1.7. If taking heparin within 48 hours, a normal activated prothrombin time (aPT)

When can you not give fibrinolytic therapy?

When the decision to treat a patient experiencing a STEMI with fibrinolytic therapy is made, because primary PCI is not available in a timely fashion, contraindications must be considered; suspected aortic dissection, active bleeding (excluding menses) or a bleeding diathesis are contraindications to fibrinolytic …

What are the contraindications of alteplase?

Due to an increased risk for bleeding, alteplase is contraindicated in patients being treated for acute myocardial infarction or pulmonary embolism with the following concomitant conditions: severe uncontrolled hypertension, aneurysm or arteriovenous malformation; known coagulopathy or bleeding diathesis; active …

When should you not use fibrinolytic therapy?

What is the time frame for fibrinolytic therapy?

During STEMI, fibrinolytic therapy must be instituted within 24 hours of symptom onset. After this time frame, fibrinolytic therapy is contraindicated and likely will not be effective.

What causes fibrinolysis?

Primary fibrinolysis occurs naturally and secondary fibrinolysis occurs due to an external cause such as medicine or a medical disorder. Fibrinolysis is tightly controlled by the actions of various cofactors, inhibitors, and receptors. Plasmin is the main protein that activates fibrinolysis.

Are there any absolute contraindications to fibrinolytic therapy?

Relative contraindications (not absolute) to fibrinolytic therapy include: Uncontrolled hypertension (BP > 180/110), either currently or in the past. Intracranial abnormality not listed as absolute contraindication (i.e. benign intracranial tumor) Ischemic stroke more than 3 months prior.

When to use fibrinolytic therapy in STEMI patients?

In the absence of contraindications, fibrinolytic therapy should be administered to STEMI patients with symptom onset within the prior 12 hours and new or presumably new LBBB. (Level of Evidence: A) Class IIa 1.

When to give fibrinolytics for myocardial infarction?

Administer fibrinolytics to patients who have evidence of ongoing ischemia 12 to 24 hours after symptom onset or have a large area of the myocardium at risk or hemodynamic instability. (Class II) Avoid giving fibrinolytics in patients with ST-depression (STD) alone, unless there is a suspected posterior MI or ST-elevation (STE) in aVR.

Are there any limitations to UFH in mi?

There are a number of intrinsic limitations to UFH therapy in patients with acute myocardial infarction (MI). The most important is that the heparin-antithrombin complex cannot bind or inactivate thrombin bound within a clot [ 1 ].