Caution is advised when enoxaparin is administered to patients Table 6. Contraindications and Cautions for Fibrinolytic Therapy in STEMI* Absolute contraindications Any prior ICH Known structural cerebral vascular lesion (eg, arteriovenous malformation) Known malignant intracranial neoplasm (primary or metastatic) Ischemic stroke within 3 mo EXCEPT acute ischemic stroke within 4.5 h Suspected aortic dissection Active bleeding or bleeding diathesis (excluding menses) Significant closed-head or facial trauma within 3 mo Intracranial or intraspinal surgery within 2 mo Severe uncontrolled hypertension (unresponsive to emergency therapy) For streptokinase, prior treatment within the previous 6 mo Relative contraindications History of chronic, severe, poorly controlled hypertension Significant hypertension on presentation (SBP >180 mmHg or DBP >110 mmHg) History of prior ischemic stroke >3 mo Dementia Known intracranial pathology not covered in absolute contraindications Traumatic or prolonged (>10 min) CPR Major surgery (<3 wk) Recent (within 2 to 4 wk) internal bleeding Noncompressible vascular punctures Pregnancy Active peptic ulcer Oral anticoagulant therapy *Viewed as advisory for clinical decision making and may not be all-inclusive or definitive. CPR indicates cardiopulmonary resuscitation; DBP; diastolic blood pressure; ICH, intracranial hemorrhage; SBP, systolic blood pressure; and STEMI, ST- elevation myocardial infarction. O Gara et al 2013 ACCF/AHA STEMI Guideline e381 with impaired renal function.340 Fondaparinux should not be given as the sole anticoagulant to patients referred for PCI and is contraindicated for patients with a creatinine clearance <30 Bivalirudin may be used for patients treated with a fibrinolytic agent who develop HIT and require continued 5.2. 