Fast Five Quiz: Test Your Knowledge of Venous Thromboembolism

Cheong Jun Lee, MD


December 03, 2018

Recent cranial surgery or head trauma is one of several absolute contraindications for thrombolysis. Biopsy within 10 days, recent surgery, nonhemorrhagic stroke, and major surgery or traumas within the past 2 weeks are relative contraindications to thrombolysis.

Thrombolysis is indicated in patients who have acute PE associated with hemodynamic instability but who are not predisposed to bleeding. According to the CHEST Guideline and Expert Panel Report on Antithrombotic Therapy for VTE Disease, several absolute and relative contraindications for therapy exist.

Some of the absolute and relative contraindications for thrombolytic therapy for DVT from the ACCP guidelines are listed below (not complete list).

Absolute contraindications:

  • Gastrointestinal bleeding within the past 6 months

  • Active or recent internal bleeding

  • History of hemorrhagic stroke

  • Nonhemorrhagic stroke within the past 3 months

  • Intracranial or intraspinal disease

  • Recent cranial surgery or head trauma

  • Pregnancy

Relative contraindications:

  • Major surgery or trauma within the past 2 weeks

  • Biopsy within 10 days

  • Other invasive procedures

  • Procedures in a location inaccessible to external compression

  • Uncontrolled coagulation defects, such as thrombocytopenia

  • Nonhemorrhagic stroke more than 3 months ago

For more on the use of thrombolytic therapy in VTE, read here and here.


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.