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APPENDIX A:
FIBRINOLYTICS ABSOLUTE AND RELATIVE CONTRAINDICATIONS IN STEMI

The following table provides the absolute and relative contraindications health factors in regard to administering fibrinolytics
in STEMI.

TABLE A-1 Absolute and Relative Contraindications
Absolute Relative
Any prior intracranial hemorrhage History of chronic, severe, poorly controlled hypertension
Known structural cerebral vascular lesion (e.g., arteriovenous Significant hypertension on presentation (SBP >180mmHg or
malformation) DBP >110mmHg)
Known malignant intracranial neoplasm (primary or metastatic) History of prior ischemic stroke >3 months
Ischemic stroke within 3 months (EXCEPT acute ischemic stroke Dementia
within 4.5 hours)
Suspected aortic dissection Known intracranial pathology not covered in absolute
contraindications
Active bleeding or bleeding diathesis (excluding menses) Traumatic or prolonged
(>10 minutes) CPR
Significant closed-head or facial trauma within 3 months Major surgery (< 3 weeks)
Intracranial or intraspinal surgery within 2 months Recent (within 2 to 4 weeks) internal bleeding
Severe uncontrolled hypertension (unresponsive to emergency therapy) Noncompressible vascular punctures
For streptokinase, prior treatment within the previous 6 months Pregnancy
Active peptic ulcer
Oral anticoagulant therapy
Source: O’Gara PT, Kushner FG, Ascheim DD, et al. The American College of Cardiology Foundation/American Heart Association guideline
for the management of ST-elevation myocardial infarction: executive summary. Circulation. 2013;127:529–555 https://www.ahajournals.org/
doi/10.1161/CIR.0b013e3182742c84 Accessed May 2021.

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