Contraindications to fibrinolysis for peripheral artery occlusion

Major contraindications

Established cerebrovascular event (including recent TIAs)

Bleeding diathesis

Recent gastrointestinal bleeding (<10 days)

Recent (within 3 months) neurosurgery (intracranial, spinal)

Recent intracranial trauma

Relative major contraindications

Recent cardiopulmonary resuscitation

Recent major nonvascular surgery or trauma

Uncontrolled hypertension: >180 mmHg systolic, >110 mmHg diastolic

Puncture of non-compressible vessel

Intracranial tumor

Recent eye surgery

Others*

The list above gives the contraindications to fibrinolysis for peripheral arterial occlusion. Decision-making must be individualized, weighing the benefits of thrombolysis with the risk of bleeding.

TIA: transient ischemic attack.
* Other relative minor contraindications include hepatic failure, particularly with coagulopathy; bacterial endocarditis; pregnancy; and diabetic hemorrhagic retinopathy.

References:

Working Party on Thrombolysis in the Management of Limb Ischemia. Thrombolysis in the management of lower limb peripheral arterial occlusion--a consensus document. J Vasc Interv Radiol 2003; 14:S337.
Kearon C, Akl EA, Comerota AJ, et al. Antithrombotic therapy for VTE disease: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 2012; 141:e419S.
Manufacturer instructions for use; label for Cathflo Activase. United States Food and Drug Administration. https://www.accessdata.fda.gov/drugsatfda_docs/label/2015/103172s5203lbl.pdf. Accessed June 8, 2018.

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Contraindications to fibrinolysis for peripheral artery occlusion