Fast Five Quiz: Myocardial Infarction Clinical Keys

Yasmine S. Ali, MD


November 13, 2020

Absolute contraindications to fibrinolytic therapy in patients with STEMI include the following:

  • Any prior intracranial hemorrhage

  • Known structural cerebral vascular lesion

  • Known intracranial neoplasm (primary or metastatic)

  • Ischemic stroke within the past 3 months (except for acute stroke within 4.5 hours)

  • Suspected aortic dissection

  • Active bleeding or bleeding diathesis (excluding menses)

  • Significant closed-head or facial trauma within 3 months

  • Intracranial or intraspinal surgery within 2 months

  • Severe uncontrolled hypertension (unresponsive to emergency therapy)

  • For streptokinase (no longer marketed in the United States), treatment within the previous 6 months

Relative contraindications include the following:

  • History of chronic, severe, poorly controlled hypertension

  • Systolic blood pressure > 180 mm Hg or diastolic blood pressure > 110 mm Hg

  • History of ischemic stroke > 3 months prior

  • Dementia

  • Known intracranial pathology not covered in absolute contraindications

  • Traumatic or prolonged cardiopulmonary resuscitation lasting > 10 minutes

  • Recent (within 2-4 weeks) internal bleeding

  • Noncompressible vascular punctures

  • Pregnancy

  • Active peptic ulcer disease

  • Current use of anticoagulants

  • For streptokinase (no longer marketed in the United States), prior exposure (> 5 days previously) or prior allergic reaction to these agents

Read more about fibrinolytic therapy in patients with MI.

This Fast Five Quiz was excerpted and adapted from the Medscape Drugs & Diseases article Myocardial Infarction.

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