ContraindicatIons and Cautions for Fibrinolytic Used in Myocardial Infarction
Absolute Contraindications:
Previous hemorrhagic stroke at any time: other strokes or cerebrovascular events within one year
Known intracranial neoplasm
Active internal bleeding (does not include menses)
Suspect aortic dissection

Cautions / Relative Contraindications
Severe uncontrolled HTN on presentation (BP more than 180/110 mmHg)
History of prior CVA or known intra-cerebral pathology not covered in contraindications
Current use of anticoagulants in therapeutic doses (INR more than 2-3); no bleeding diathesis
Recent trauma (within 2-4 weeks) including head trauma
Noncompressible vascular punctures
Recent (within 2-4 weeks) internal bleeding
For streptokinase/anistreplase: prior exposure (especially within 5d-2 yrs) or prior allergic reaction
Active peptic ulcer
History of chronic hypertension

Primary Percutaneous Transluminal Coronary Angioplasty Recommendations
Class I Recommendations
1. As an alternative to fibrinolytic therapy if:
ST segment elevation or new or presumed new LBBB
Within 12 hrs of symptoms or more than 12 hrs of persistent pain
In a timely fashion
By experienced operators
In appropriate environment
2. In cardiogenic shock patients less than 75 yrs or within 36 hrs of AMI and revascularization can be performed within 18 hrs of onset of shock
Class IIa Recommendations
1. As reperfusion strategy in candidates for reperfusion who have contraindications to fibrinolytic therapy
Class IIb Recommendations
1. In patients with AMI who do not present with ST elevation but who have reduced (< TIMI grade 2) flow of the infarct-related artery and when angioplasty can be performed within 12 hrs of onset of symptoms
Class III Recommendations
1. This classification applies to patients with AMI who:
undergo elective angioplasty in the non-infarct-related artery at the time of AMI
are beyound 12 hrs after the onset of symptoms and have no evidence of myocardial ischemia
have received fibrinolytic therapy and have no symptoms of myocardial ischemia
are fibrinolytic-eligible and are undergoing primary angioplasty by and unskilled operator in a laboratory that does not have surgical capability.

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