Issues in thrombolysis: There may not be anything called “ Absolute contraindication ”
This post was originally written in 2013.
A middle-aged man with STEMI came to our CCU. It is just another case of STEMI and asked my fellow to lyse.
But it was not the case . He, told me, Sir, the patient had a syncope following chest pain and he has injured his face and Jaw. He was actively bleeding. When I saw this face, it was indeed frightening.
What shall we do ? When a patient with STEMI presents with bleeding facial Injury
Rush for Immediate PCI (Which was of course not possible in our place as it happened out of office hours! )
Take that ultimate risk and thrombolysis
Give only heparin ( Many times it is as good as lysis )
We took a (bold ? ) decision to thrombolyse with streptokinase.(After a CT scan which ruled out any Intracranial bleed like hematoma etc) Clopidogrel was also given.
Patient continued to bleed in the initial 3 hours and was oozing in the next 12 hours. Blood transfusion was contemplated, but it was not required. Dental surgeon opinion was sought, his teeth were pulled and a compressive bandage was applied.It arrested the bleeding.The ECG settled down.LV function was almost normal with minimal wall motion defect. He is posted for a coronary angiogram later.
Final message
There may not be anything called “Absolute contraindication” everything appears relative
I presented this in the weekly clinical meet, with a tag line of How to save a patient, apparently by violating a standard guideline. Not surprisingly, It evo...
Source: Dr.S.Venkatesan MD - Category: Cardiology Authors: dr s venkatesan Tags: bio ethics Cardiology -Therapeutic dilemma cardiology -Therapeutics Cardiology -unresolved questions Cardiology Risk assesment cardiology- coronary care Cardiology-Coronary artery disese Primary PCI Thrombolysis relative and absolute con Source Type: blogs
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