When is thrombolytic therapy indicated in STEMI, and what are key contraindications?

• A. Indicated if PCI cannot be performed within 120 minutes of first medical contact and within 12 hours of symptom onset; contraindications include active bleeding, recent intracranial surgery or stroke, hemorrhagic stroke, known bleeding disorders, severe hypertension.
• B. Indicated only if PCI is available within 90 minutes; contraindications: stable vitals, no bleeding risk.
• C. Indicated when chest pain lasts more than 6 hours; contraindications: uncomplicated hypertension.
• D. Indicated immediately for all STEMI patients; contraindications: none.

Answer: (A)

Thrombolytic therapy in STEMI is used when you cannot get prompt primary PCI. The protective goal is rapid reperfusion, so the therapy is indicated if PCI cannot be performed within about 120 minutes of first medical contact and, overall, within 12 hours of symptom onset (earlier is better).

The major contraindications are situations that markedly raise the risk of serious bleeding or hemorrhagic transformation, such as active bleeding, a history of hemorrhagic stroke or any current intracranial hemorrhage, recent intracranial surgery or head trauma, known bleeding disorders or very low platelets, and severe uncontrolled hypertension. In the presence of any of these contraindications, thrombolytic therapy should be avoided in favor of alternative reperfusion strategies, primarily primary PCI if available.