What contraindicates fibrinolytic therapy for a client with chest pain and a history of angina?

• A. Diabetes history
• B. Stroke history
• C. Hypertension history
• D. Atrial fibrillation history

Answer: (B)

Fibrinolytic therapy is commonly used in the management of acute myocardial infarction (AMI) to dissolve blood clots. However, certain conditions can contraindicate its use due to an increased risk of bleeding complications. A history of stroke is particularly significant because it indicates that the patient may have already experienced a cerebrovascular accident, which increases the likelihood of re-bleeding or hemorrhage if fibrinolytic therapy is administered.

In patients with a history of stroke, especially if it occurred within a certain time frame (such as within the last three months), the risks of using fibrinolytics outweigh the potential benefits. This is primarily due to the medication’s effect on the vascular system, which can lead to bleeding in the brain or other vital organs.

While diabetes history, hypertension history, and atrial fibrillation history can present other risks and considerations when managing chest pain or myocardial infarction, they do not carry the same high level of risk for bleeding that a recent history of stroke does. Hence, the presence of a stroke history is the critical factor that contraindicates the use of fibrinolytic therapy in this scenario.