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.
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