contraindications to thrombolytic therapy

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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.

Last reviewed 01/2018