62. What are the contraindications to using fibrinolytic therapy (thrombolytic therapy) to treat an acute myocardial infarction?

Absolute contraindications are:

- Prior intracranial hemorrhage
- Ischemic stroke within 3 months
- Acute gastrointestinal bleeding
- Known intracranial tumor/AV malformation
- Significant closed head/facial trauma within 3 months
- Suspected aortic dissection

Relative contraindications are:

- Uncontrolled hypertension (defined as systolic blood pressure > 180 mmHg)
- Ischemic stroke more than 3 months prior
- Dementia or other intracranial abnormality (not mentioned in absolute contraindications)
- Recent internal bleeding (within 4 weeks)
- Trauma or prolonged cardiopulmonary resuscitation or recent surgery (within 3 weeks)
- Prior allergic reaction or recent use of streptokinase
- Current use of anticoagulants
- Non-compressible vascular puncture
- Pregnancy

The age of the patient is controversial. In general, age > 75 is at higher risk, but still considered safe to use thrombolytics.