Contraindications to thrombolytic therapy

The contra-indications to streptokinase include:

• known active bleeding source e.g. peptic ulcer, active dyspepsia
• active menstruation
• cerebrovascular accident within 3 months
• surgery or head injury within last 3 months
• severe hypertension:
  • systolic more than 200 mm HG or diastolic more than 100 mm Hg
  • must be sustained e.g. not responding to i.v. nitrates
• hypotension:
  • systolic less than 90 mm Hg and not corrected by atropine (if bradycardia) or other rhythm correction
• chest trauma due to prolonged cardiac massage - if CPR more than 5 minutes assess risks with senior staff
• on warfarin
• known or suspected aortic aneurysm
• known sensitivity to streptokinase or prior administration within last 24 months
• known recent streptococcal infection

Note that these criteria are continually under review and may differ between centres. Proliferative diabetic retinopathy is no longer considered a contraindication. If any doubt, always consult with a senior member of the cardiology team.

If streptokinase is contraindicated, consider an alternative such as t-PA.

Reference

1. Muhammad U. Baig, Jeffrey Bodle. Thrombolytic Therapy. StatPearls Publishing 2024 Jan