"Contraindications" to thrombolysis and their
utilisation in the A+E department by medical on-call
teams gives me no end of delight and dinner stories...
When talking about relative contrindications, I often
ask them "relative to what?" If the infarct is big
enough then it may well be relative to death....I
would rather take my chances with thriombolysis.
If the patient is with-it...I always let them be part
of the decision making process.
In the case of elderly diabetics...I find they would
usually be alive and blind than not receive
thrombolysis.
In your case, assuming the diagnosis was correct, the
patient may well die or be chronically incapacitated
from an extensive anterior infarct, presumably a
proximal left sided coranary lesion, that has happened
despite concurrent anticoagulation therapy.
Irrespective of the INR....the patient has still
extended a clot.
I agree with you....(Assuming the patient wasn't
actively bleeding elsewhere) I would have
thrombolysed.
S Bell
SpR UHL
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