Which of the following is an ABSOLUTE contraindication to fibrinolytic therapy in a patient presenting with STEMI where primary PCI is unavailable?
- A Ischemic stroke occurring 8 months ago
- B Active peptic ulcer bleeding at presentation ✓
- C Systolic blood pressure of 175 mmHg on arrival
- D Pregnancy at 20 weeks of gestation
Correct answer: B. Active peptic ulcer bleeding at presentation
Explanation
Any active internal bleeding is an absolute contraindication to fibrinolysis because lytic therapy converts hemostatic plugs into unstable ones. Prior ischemic stroke beyond 6 months, pregnancy, and severe uncontrolled hypertension above 180/110 mmHg are relative contraindications where the benefit may still outweigh risk in massive STEMI. Indian exam convention follows the standard ACC/AHA and ESC contraindication lists on this point.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.