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
- 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.