AHA: Checklist for Fibrinolytic Therapy

This blog will provide you with the checklist for Fibrinolytic therapy which should be kept in mind at the time of stroke management.

The main objective of stroke care is to reduce injury to the brain and to prevent neurological deficits. Patients with ST-elevation myocardial infarction (STEMI) are treated with Fibrinolytic therapy in the following conditions:

1. Patients who are found to be symptomatic (Chest pain) for longer than 15 minutes but less than 12 hours.
2. ECG is considered as one of the important diagnostic tool for ST elevation, pointing towards a Myocardial infarction or a new Left Bundle Branch Block.
3. If any of the following circumstances are observed, a PCI capable facility is suggested:
   • If the heart rate is found to be higher than 100 per minute in the presence of a systolic blood pressure less than 100 mm Hg
   • Occurrence of signs indicating pulmonary edema, for example, rales
   • Cool and clammy type skin indicating the possibility of shock
   • During the time of administration of fibrinolytics, contraindications are found.

Although Fibrinolytic therapy is recommended in the treatment of stroke, but sometimes it may be contraindicated in some cases that include:

• In case of patients with hypertension when the systolic blood pressure is found to be greater than 180 mm Hg with an elevated diastolic blood pressure that is higher than 110 mm Hg,
• If the difference between the right and left arm systolic pressure is more than 15 mm Hg,
• Presence of history of structural CNS disease is another possible complication,
• Occurrence of any remarkable head or face trauma in the previous 90 days,
• One relative contraindication is the presence of major trauma, surgery or gastrointestinal or genitourinary bleed in the last 6 weeks,
• Presence of any bleeding or clotting disorders in earlier period,
• If CPR has been implemented for more than 10 minutes,
• Presence of any severe chronic disease i.e. liver or kidney disease or advanced cancer, is also considered as possible contraindication of fibrinolytic therapy.

A flowchart of checklist for Fibrinolytic Therapy with step-by-step description is given below:

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