Which of the following is an absolute contraindication to thrombolytic therapy?

• A. Active bleeding
• B. Uncontrolled hypertension
• C. Recent major surgery within 3 weeks
• D. Pregnancy

Answer: (A)

The key idea is that thrombolytics dissolve clots but dramatically raise the risk of bleeding. If there is active bleeding, giving a thrombolytic would worsen the bleeding and could be fatal, so active bleeding is an absolute contraindication—there is no safe scenario in which you would proceed with lysis.

Uncontrolled hypertension, recent major surgery, and pregnancy are not absolute contraindications. They are considered relative contraindications, meaning the decision depends on weighing risks and benefits and often requires stabilizing or special considerations first. For example, uncontrolled blood pressure raises the danger of intracranial hemorrhage during lysis, but if blood pressure can be safely controlled, thrombolysis may be contemplated. Recent surgery increases bleeding risk, but the procedure’s timing and the patient’s overall status guide the decision. Pregnancy adds risk to both mother and fetus, so a careful, case-by-case assessment is required rather than an outright prohibition.