You are assessing eligibility for streptokinase in a 66-year-old man presenting with an inferior STEMI 3 hours after symptom onset. Which of the following findings in his history is an ABSOLUTE contraindication to fibrinolytic therapy?
- A Active gastrointestinal bleeding from a peptic ulcer today ✓
- B Blood pressure of 185/112 mmHg on arrival
- C Ischaemic stroke 6 years ago with full recovery
- D Prolonged CPR of 12 minutes performed last month
Correct answer: A. Active gastrointestinal bleeding from a peptic ulcer today
Explanation
Active internal bleeding is an absolute contraindication because fibrinolysis will worsen haemorrhage catastrophically. Other absolutes include any prior intracranial haemorrhage, ischaemic stroke within 3 months, known intracranial neoplasm or vascular malformation, and suspected aortic dissection. Remote ischaemic stroke beyond 3 months, severe hypertension above 180/110 mmHg that can be lowered, recent prolonged CPR, and pregnancy are classified as relative contraindications requiring risk-benefit judgement.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.