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Home | Articles | Cardiac | STEMI Thrombolysis Protocol

STEMI Thrombolysis Protocol

Last updated 27th March 2025

Introduction

  1. PCI strategy is recommended over Thrombolysis within indicated time frames (time to reperfusion ≤120 mins from diagnostic ECG). This is roughly broken down as:
    • 20 mins to leave scene
    • 70 mins transfer time
    • 30 mins door to balloon time at PCI centre
  2. Email ECG to [email protected] and then phone the on call Cardiologist at Hairmyres on 01355 584817 (or 01355 584819 if line busy) to discuss whether to arrange emergency transfer to Hairmyres or thrombolyse.
  3. If timely PCI cannot be performed after STEMI diagnosis, thrombolysis is recommended within 6 hours of symptom onset (greatest benefit within 3 hours), in patients without contraindications.

Absolute Contraindications to Thrombolysis

  1. Haemorrhagic stroke or stroke of unknown origin at any time
  2. Ischaemic stroke in preceding 6 months
  3. Central nervous system damage / neoplasms
  4. Major trauma / surgery / head injury within preceding 3 weeks
  5. Gastrointestinal bleeding within the last month
  6. Known bleeding disorderAortic dissection

Relative Contraindication – Discuss with Senior Staff Before Withholding

  1. Transient ischaemic attack in preceding 6 months
  2. Oral anticoagulant therapy
  3. Pregnancy or within 1-month post-partum
  4. Non-compressible punctures <24 hours
  5. Traumatic resuscitation
  6. Refractory hypertension (systolic BP >180mmHg) [IV GTN infusion if required]
  7. Advanced liver disease
  8. Infective endocarditis
  9. Active peptic ulcer
  10. Terminal illness

STEMI Thrombolysis Protocol

  1. Once decision has been made for thrombolysis, do so promptly. Target time form diagnostic ECG to thrombolysis is 10 mins.
  2. Drugs and dosages are as follows
    • Tenecteplase (see table below for dosages) – bolus over 10 seconds; half dose if age ≥75
    • Aspirin 300mg
    • Clopidogrel 300mg (75mg if age ≥75)
    • IV Unfractionated Heparin bolus 5000units
  3. Immediate transfer to Hairmyres and advise Hairmyres CCU of ETA (do not wait to assess reperfusion).

Tenecteplase Single Weight Adjusted Bolus over 10 Seconds  – Half dose if age ≥75

Weight
Weight (Imperial)
Tenecteplase (Units)
Tenecteplase (mg)
<60kg
<9st 6lb
6,000
30
60-69.9kg
9st 6lb-11st
7,000
35
70-79.9kg
11st 1lb-12st 8lb
8,000
40
80-89.9kg
12st 9lb-14st 2lb
9,000
45
≥90kg
>14st 2lb
10,000
50mg (Max dose)

Following Thrombolysis

  1. Perform 60-90 minute ECG to assess reperfusion.
  2. Rescue PCI is indicated immediately when fibrinolysis has failed (<50% ST-segment resolution at 60-90 mins).
  3. Angiography and PCI of the infarct related artery, if indicated, is recommended between 2 and 24 hours after successful fibrinolysis.
  4. Anticoagulation with treatment dose subcutaneous Enoxaparin (1mg/kg BD) should be administered in Hairmyres CCU, until coronary angiography.

Links

Hairmyres ORS Thrombolysis Decision Flowchart [pdf]