Absolute contraindication to thrombolytic therapy in acute ST-segment elevation MI includes which finding?

• A. History of severe hypertension presently controlled
• B. Current use of anticoagulation therapy
• C. Previous hemorrhagic stroke
• D. Active peptic ulcer disease

Answer: (C)

Thrombolytic therapy carries a high risk of bleeding, especially into the brain. A history of hemorrhagic stroke signals a brain that has already bled, so giving a clot-dissolving drug could trigger another intracranial hemorrhage with devastating consequences. That’s why prior hemorrhagic stroke is an absolute contraindication to thrombolysis in acute STEMI. The other findings raise bleeding risk or complicate therapy but are not absolute barriers: being on anticoagulation increases bleeding risk and may be considered a relative contraindication depending on specifics; active peptic ulcer disease raises GI bleeding risk but isn’t an outright impossibility in all cases; controlled severe hypertension isn’t an absolute contraindication.