What is an absolute contraindication to fibrinolytic therapy in the setting described?

What is an absolute contraindication to fibrinolytic therapy in the setting described?

• A. Active bleeding
• B. A history of an ischemic stroke within the past 3 months unless the stroke is diagnosed within 4½ hours
• C. Recent antibiotic use
• D. Uncontrolled hypertension

Answer: (B)

A recent ischemic stroke within the past three months is an absolute contraindication to fibrinolytic therapy because the brain tissue that was recently infarcted has fragile blood vessels and a disrupted blood-brain barrier. Administering a thrombolytic agent in this setting greatly increases the risk of hemorrhagic transformation, which can lead to intracerebral hemorrhage and worsen disability or be fatal. This risk is why a recent ischemic stroke within three months overrides other considerations when deciding about fibrinolysis. Other factors like active bleeding are also serious concerns, but the scenario points to the recent stroke as the definitive barrier to using lytics. Uncontrolled hypertension and prior antibiotic use do not carry the same level of absolute contraindication in this context.

A recent ischemic stroke within the past three months is an absolute contraindication to fibrinolytic therapy because the brain tissue that was recently infarcted has fragile blood vessels and a disrupted blood-brain barrier. Administering a thrombolytic agent in this setting greatly increases the risk of hemorrhagic transformation, which can lead to intracerebral hemorrhage and worsen disability or be fatal. This risk is why a recent ischemic stroke within three months overrides other considerations when deciding about fibrinolysis.

Other factors like active bleeding are also serious concerns, but the scenario points to the recent stroke as the definitive barrier to using lytics. Uncontrolled hypertension and prior antibiotic use do not carry the same level of absolute contraindication in this context.