heart doctors in Doddabommasandra, Bangalore • Thrombolysis Contraindications to thrombolytic (fibrinolytic) treatment The following important contraindications to thrombolytic treatment must be considered rapidly before a decision to treat is made. They mostly relate to bleeding problems or risk. 1 Prolonged resuscitation following a cardiac arrest. Brief periods of cardiac massage should not prevent treatment. 2 Active peptic ulcer disease. 3 A recent surgical operation (up to 10 days, depending on the extent of the operation). 4 A previous haemorrhagic stroke. 5 Previous use of streptokinase probably means that agent should not be used again. Antibodies develop quickly and may cause allergic reactions and reduce the effectiveness of the drug. The usual approach is to use tissue plasminogen activator for these patients. 6 Diabetic retinopathy with a history of retinal haemorrhage. Thrombolytic treatment can be begun in the accident and emergency department or, if transfer is not delayed, in the CCU. Some successful trials of administration by ambulance officers have been conducted. This is especially useful if transfer to hospital is likely to take a long time. Staff in the department where the drug is given must be well informed about complications and their management. Some patients develop hypotension after the commencement of streptokinase. The drug infusion rate should then be slowed but not stopped. Reperfusion arrhythmias may develop in response to lysis (or balloon dilatation) of the thrombus. It is thought that metabolites washed from the ischaemic zone down the newly patent artery can cause electrical instability. These arrhythmias are usually self-limiting but occasionally ventricular tachycardia or fibrillation may occur. This is always awkward if it occurs in the lift on the way to the CCU. Other irregularities such as flurries of ventricular ectopics, periods of accelerated idioventricular rhythm (AIVR) or fascicular VT may occur. Successful thrombolysis may be difficult to diagnose at the bedside but the relief of pain,