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Thrombolytic therapy is contraindicated in the patient with an actively bleeding ulcer. Other exclusion criteria include any known active bleeding or bleeding diathesis, recent stroke, other intracranial disease, recent surgery or trauma, prolonged or traumatic CPR and severe hypertension. Unlike thrombolytic therapy, primary angioplasty improves survival in patients with STEMI presenting in cardiogenic shock.

Our patient presents with evidence of a large anterior ST elevation MI, and a past history of a bleeding ulcer, Since she has a negative stool hemoccult and no evidence of a recent bleed, thrombolytic therapy may be considered if timely primary angioplasty is not readily available. If the anticipated delay in achieving invasive reperfusion is more than sixty minutes beyond the anticipated time to administration of thrombolytics, then thrombolytic therapy should be administered.