Which of the following is a contraindication to administration of tissue plasminogen activator (tPA) in acute MI?

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Multiple Choice

Which of the following is a contraindication to administration of tissue plasminogen activator (tPA) in acute MI?

The key idea is safety in using fibrinolysis for a heart attack. Giving tissue plasminogen activator dissolves clots but also greatly increases bleeding risk, especially in the brain. Severe hypertension magnifies that risk, so elevated blood pressure is a contraindication to tPA until the BP can be brought down to a safer range (generally ≤180/110 mmHg) with prompt treatment and reassessment. If BP can be controlled, thrombolysis can be considered; if not, it should be delayed. Regular exercise and adequate hydration do not increase bleeding risk in a way that would prevent tPA, so they’re not contraindications. Low blood pressure by itself isn’t an automatic withholding criterion for tPA; it depends on the overall clinical context and stability, though profound hypotension would prompt careful evaluation and stabilization before proceeding.

The key idea is safety in using fibrinolysis for a heart attack. Giving tissue plasminogen activator dissolves clots but also greatly increases bleeding risk, especially in the brain. Severe hypertension magnifies that risk, so elevated blood pressure is a contraindication to tPA until the BP can be brought down to a safer range (generally ≤180/110 mmHg) with prompt treatment and reassessment. If BP can be controlled, thrombolysis can be considered; if not, it should be delayed.

Regular exercise and adequate hydration do not increase bleeding risk in a way that would prevent tPA, so they’re not contraindications. Low blood pressure by itself isn’t an automatic withholding criterion for tPA; it depends on the overall clinical context and stability, though profound hypotension would prompt careful evaluation and stabilization before proceeding.

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