The document lists several indications for thrombolysis and percutaneous coronary intervention (PCI). Thrombolysis is indicated for conditions involving thrombosis including acute myocardial infarction, deep vein thrombosis, pulmonary embolism, and acute ischemic stroke. PCI is indicated for chronic stable angina and acute coronary syndromes. For STEMI, primary PCI is preferred over thrombolysis if it can be performed within 120 minutes of diagnosis, otherwise immediate thrombolysis should be administered.

1. INDICATIONS FOR THROMBOLYSIS
• Acute myocardial infarction [AMI]
• Deep vein thrombosis [DVT]
• Pulmonary embolism [PE]
• Acute ischemic stroke [AIS]
• Acute peripheral arterial occlusion
• Occlusion of indwelling catheters
• Intracardiac thrombus formation
• Severe frostbite

2. INDICATIONS FOR PTCA
• Chronic stable angina :
The main aim of treatment is to improve symptoms to reduce mortality:
- In asymptomatic or mildly symptomatic patients,revascularization can be
deferred if procedural risks/bleeding risks are high.PCI is warranted only
if symptoms worsen or there is evidence of severe ischemia on non
invasive testing in spite of optimal medical therapy.
- Moderate to severely symptomatic patients should
undergo ischemia-guided revascularization.
- Less severe multi-vessel disease with or without
diabetes have equal outcomes with PCI and CABG.

3. • Absolute contractions
• Any previous intracranial hemorrhage
• Known structural cerebral vascular lesion (AV malformations)
• Known malignant intra cranial neoplasm(primary or metastatic)
• Ischemic stroke within 3 months except acute ischemic stroke within
4.5 hrs
• Suspected aortic dissection
• Active bleeding or bleeding diathesis
• Significant closed head or facial trauma within 3 months.
• Intra cranial or intra spinal surgery within 2 months
• Severe uncontrolled hypertension (unresponsive to emergency
therapy)
• For streptokinase, previous treatment within previous 6 months.

4. • RELATIVE CONTRAINDICATIONS
• History of chronic, severe, poorly controlled hypertension.
• Significant hypertension at initial evaluation (SP> 180mmhg or
DBP>110mmhg)
• History of previous ischemic stroke > 3 months.
• Dementia
• Known intracranial pathology not covered in absolute contra indications
• Traumatic or prolonged cardio pulmonary resuscitation.
• Major surgery (< 3 weeks
• Recent within (2-4 weeks) internal bleeding
• Non compressive vascular punctures
• Pregnancy
• Active peptic ulcer
• Oral anti coagulant therapy

5. ACUTE CORONARY SYNDROMES:
- PCI is superior to optimal medical management due to high risk of mortality. PCI
is preferred over CABG surgery except in case of severe multi-vessel
disease or anatomical factors which are
not amenable to successful treatment.
• „elevation myocardial infarction (STEMI):
• —— Primary PCI (Primary angioplasty in Myocardial
• Infarction—PAMI) is a preferred strategy (direct
• intervention without thrombolysis).
• —— In the pharmaco-invasive approach, patients are
• thrombolyzed followed by PCI within 2–24 hours
• after thrombolysis.
• —— In case of failed thrombolytic therapy (patients in
• whom there is ongoing angina 90 minutes after
• fibrinolysis and/or ECG persistently shows ST
• elevation), Rescue PCI should be performed.

6. • STEMI DIAGNOSIS < 10 mins
• Once stemi is diagnosed,
• If estimated time taken to reach PCI capable centre and undergo PCI
is less than 120 mins, refer the patient
• With an intend to get PCI with wire crossing within 90 mins.
• Grace period of 30mins to arrange and transport.
• If the distance to PCI capable centre is far and it takes more than 120
mins ,
• Immediately thrombolyse the patient within 10 mins, with preferably
bolus lytics like, Tenecteplase or alteplase

7. • After lytic bolus,
• refer to PCI cetre ASAP
60-90 mins
Succesful lysis
Failed lysis
Pharmaco invasive PCI Immediate rescue PCI
After 60-90 mins of lysis, ecg to be taken to find success of lysis