What are major contraindications for thrombolytic therapy in ACS?

• A. Active bleeding, recent surgery, hemorrhagic stroke, severe hypertension.
• B. Hypertension controlled with lifestyle changes.
• C. Hyperlipidemia with stable labs.
• D. Chronic stable angina.

Answer: (A)

The key idea is that thrombolytics carry a high risk of causing dangerous bleeding, especially into the brain. Major contraindications are conditions that massively increase that bleeding risk: active bleeding at any site, a recent surgery or major trauma (which leaves a vulnerable healing wound), a history of hemorrhagic stroke, and severe, uncontrolled hypertension. In these situations dissolving clots could provoke life-threatening intracranial or systemic bleeding, so thrombolysis is avoided.

Other scenarios listed don’t inherently raise the bleeding risk to the same level. Hypertension that is well controlled with treatment, hyperlipidemia with stable labs, or chronic stable angina do not by themselves constitute absolute contraindications to thrombolysis. They may influence overall risk assessment or the choice of revascularization strategy, but they aren’t in themselves disqualifying for thrombolytic therapy.