Which of the following is a relative contraindication to thrombolytic therapy?

• A. Uncontrolled hypertension
• B. Active bleeding
• C. Intracranial hemorrhage within last year
• D. Noncompressible vascular punctures

Answer: (A)

Thrombolytic therapy increases bleeding risk, so decisions hinge on whether the bleeding risk can be kept acceptably low. Uncontrolled hypertension is a relative contraindication because very high blood pressure raises the chance of intracranial hemorrhage once lysis is given. If you can rapidly lower and control the blood pressure to a safe range and there are no other absolute contraindications, thrombolysis may still be considered with close monitoring.

In contrast, active bleeding presents an ongoing bleeding problem that would be worsened by clot-dissolving drugs, making thrombolysis unsafe. A recent intracranial hemorrhage signals a high risk of rebleeding in the brain and severe outcomes, which is why it is a much stronger contraindication. Noncompressible vascular punctures indicate sites where bleeding cannot be easily controlled, again posing a high risk if systemic lysis were administered.