Contraindications to fibrinolytic therapy for deep venous thrombosis or acute pulmonary embolism

Absolute contraindications

Prior intracranial hemorrhage
Known structural cerebral vascular lesion
Known malignant intracranial neoplasm
Ischemic stroke within 3 months (excluding stroke within 3 hours*)
Suspected aortic dissection
Active bleeding or bleeding diathesis (excluding menses)
Significant closed-head trauma or facial trauma within 3 months

Relative contraindications

History of chronic, severe, poorly controlled hypertension
Severe uncontrolled hypertension on presentation (SBP >180 mmHg or DBP >110 mmHg)
History of ischemic stroke >3 months prior
Traumatic or prolonged (>10 minutes) CPR or major surgery <3 weeks
Recent (within 2 to 4 weeks) internal bleeding
Noncompressible vascular punctures
Recent invasive procedure
For streptokinase/anistreplase – Prior exposure (>5 days ago) or prior allergic reaction to these agents
Pregnancy
Active peptic ulcer
Pericarditis or pericardial fluid
Current use of anticoagulant (eg, warfarin sodium) that has produced an elevated INR >1.7 or PT >15 seconds
Age >75 years
Diabetic retinopathy

SBP: systolic blood pressure; DBP: diastolic blood pressure; CPR: cardiopulmonary resuscitation; INR: international normalized ratio; PT: prothrombin time.

* The American College of Cardiology suggests that select patients with stroke may benefit from thrombolytic therapy within 4.5 hours of the onset of symptoms.

Reproduced with permission from the American College of Chest Physicians. Kearon C, Akl EA, Comerota AJ, et al. Antithrombotic therapy for VTE disease: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 2012; 141:e419S. Copyright © 2012.

Graphic 95035 Version 5.0

خرید پکیج

Contraindications to fibrinolytic therapy for deep venous thrombosis or acute pulmonary embolism