Who is eligible for thrombolytic therapy?

These are the eligibility/exclusion criteria for thrombolytic therapy for acute myocardial infarction from the National Heart, Lung, and Blood Institute in Bethesda, MD:

Eligibility criteria

• Clinical chest pain or chest-pain equivalent syndrome consistent with acute myocardial infarction (AMI) of 12 hours or less from symptom onset with electrocardiogram of:

1 mm or more ST elevation in two or more contiguous limb leads;

2 mm or more ST elevation in two or more contiguous precordial leads;

new bundle branch block.

Cardiogenic shock emergency catheterization and revascularization; if possible, consider thrombolysis if catheterization is not immediately available.

Contraindications

• Absolute require consideration of other reperfusion strategy such as angioplasty or open-heart surgery:

altered consciousness;

active internal bleeding;

known spinal cord or cerebral arteriovenous malformation or tumor;

recent head trauma;

known previous hemorrhagic cerebrovascular accident;

intracranial or intraspinal surgery within two months;

trauma or surgery within two weeks, which could result in bleeding into a closed space;

persistent blood pressure of more than 200/120 mm/Hg;

known bleeding disorder;

pregnancy;

suspected aortic dissection;

previous allergy to a streptokinase product (but not a contraindication to use of other thrombolytic agents).

• Relative:

active peptic ulcer disease;

a history of ischemic or embolic cerebrovascular accident;

current use of oral anticoagulants;

major trauma or surgery two weeks to two months earlier;

history of chronic, uncontrolled hypertension (diastolic >100 mm/Hg), treated or untreated;

subsclavian or internal jugular cannulation.