ABSTRACT

The clearest indication for thrombolytics is hemodynamic instability, in the absence of absolute contraindications. Contraindications to thrombolytic therapy include: current internal bleeding, recent trauma, major surgery or head injury (within the previous 6 weeks), acute cerebrovascular hemorrhage or a cerebrovascular procedure within the previous 2-3 months. Other relative contraindications include: cerebrovascular event within 6 months, a 10 day or shorter post-partum period, recent organ biopsy or puncture of a non-compressible vessel, uncontrolled bleeding diathesis, recent serious internal trauma, pregnancy, cardiopulmonary resuscitation with rib fractures, thoracentesis, paracentesis, lumbar puncture, or any condition that places the patient at an increased risk for bleeding. Most bleeding episodes occur in patients undergoing invasive procedures. Major bleeding complications for PE are approximately 14% in patients undergoing pulmonary angiograms, but only 4% in patients having V/Q scans28. If bleeding occurs during therapy, discontinuation of treatment usually is all that is required to control bleeding. However, with ongoing bleeding, cryoprecipitate infusion targeted to attain a fibrinogen level of 100 mg dl-1 or more is indicated. If bleeding persists, the administration of fresh frozen plasma should be considered. In the presence of ongoing life-threatening hemorrhage following thrombolytic therapy, antifibrinolytic therapy with e-aminocaproic acid is indicated.