AKA fibrinolytic therapy, is the breakdown of blood thots formed in blood vessels using medication (Alteplase, Tenecteplase, Reteplase)

Indications

• Cannot be treated with PCI within 90min
• Chest pain > 30 minutes and < 12 hours
• ECG changes
• Hx of MI

Contraindications

• Absolute
  • Active bleeding
  • Suspected aortic dissection
  • Significant closed head or facial trauma within 3 months
  • History of intracranial haemorrhage
  • Ischemic stroke within 3 months
  • Known cerebrovascular lesion
  • Known malignant intracranial neoplasm
• Relative
  • On anticoagulants
  • Major surgery in the last 3 weeks
  • Traumatic / prolonged CPR (greater than 10 minutes)
  • Recent internal bleed (4 weeks)
  • Suspected pericarditis
  • Advanced liver Disease
  • Advanced metastatic cancer
  • History of chronic, severe, poorly controlled hypertension
  • Dementia
  • Pregnant or within 1-week post-partum

Complications

• Bleeding
• Adverse drug reaction