Thrombolytic therapy: 11 contraindications

Although some studies have shown an increased risk of cerebral hemorrhage in elderly patients receiving thrombolytic therapy, you need to screen closely for contraindications, urges Odette Comeau-Luis, RN, a clinical specialist in cardiac care at Loma Linda (CA) University Medical Center.1,2

While there are no age contraindications for receiving thrombolytic therapy, the decision to treat should be based on a risk-to-benefit ratio for all patients, Comeau-Luis stresses. Contraindications for thrombolytic therapy include the following:

• major surgery or trauma within 10 days;

• history of central nervous system hemorrhage, tumor, aneurysm, or atrioventricular valve malformation;

• hemorrhagic stroke within six months;

• spinal or intracranial surgery within three months;

• coma;

• bleeding diathesis, i.e., thrombocytopenia, hemophilia, platelet dysfunction, etc.

• for streptokinase, prior administration within one year;

• prolonged cardiopulmonary resuscitation (>10 minutes);

• pregnancy;

• gastrointestinal or internal bleeding within three months;

• severe uncontrolled hypertension (>200/110).

References

1. Jahnigen D, Schrier R. Geriatric Medicine. Cambridge, MA: Blackwell Science; 1996.

2. Rich M. Therapy for acute myocardial infarction in older persons. J Am Geriatr Soc 1998; 46:1,302-1,307.