Thrombolytic therapy, while effective for certain acute conditions (e.g., STEMI, acute ischemic stroke), carries significant risks of bleeding. Contraindications to thrombolytic therapy are categorized as Absolute, Relative, and Minor.
Absolute Contraindications To Thrombolytic Therapy
Thrombolytic agents must not be administered in the presence of the following conditions due to high risk of life-threatening hemorrhage:
| Condition | Timeframe/Description |
| Established Cerebrovascular Events | Including transient ischemic attack (TIA) within the last 3 months. |
| Active Bleeding Diathesis | Any current condition causing abnormal bleeding. |
| Recent Gastrointestinal Bleeding | Bleeding occurring within the last 10 days. |
| Neurosurgery (Intracranial or Spinal) | Surgery performed within the last 3 months. |
| Intracranial Trauma | Significant head trauma occurring within the last 3 months. |
| Intracranial Malignancy or Metastasis | Presence of cancer within the brain. |
Relative Contraindications TO Thrombolytic Therapy
These conditions necessitate careful clinical judgment and risk-benefit analysis. Thrombolysis may be considered if the expected benefit significantly outweighs the bleeding risk.
| Condition | Timeframe/Description |
| Cardiopulmonary Resuscitation (CPR) | CPR performed within the last 10 days. |
| Major Nonvascular Surgery or Trauma | Surgery or trauma occurring within the last 10 days. |
| Uncontrolled Hypertension | Systolic Blood Pressure $(\text{SBP}) > 180 \text{ mmHg}$ or Diastolic Blood Pressure $(\text{DBP}) > 110 \text{ mmHg}$. |
| Puncture of Non-Compressible Vessel | Recent puncture or instrumentation in a location where bleeding cannot be manually controlled. |
| Intracranial Tumor | Non-malignant brain tumor. |
| Recent Eye Surgery |
Minor Contraindications
These factors should be considered, but generally do not preclude therapy if the indication is strong.
- Hepatic Failure, particularly with coagulopathy
- Bacterial Endocarditis
- Pregnancy
- Diabetic Hemorrhagic Retinopathy