In the absence of contraindications, should be given to STEMI patients with symptoms <12 hours when it is anticipated that primary PCI cannot be performed within 120 minutes of FMC (class I) 

Up to 12-24 hours of symptoms with STEMI when PCI unavailable (class IIa) 

Non-PCI capable hospital and the total time it would take to transfer to a PCI-capable hospital and FMC–device time is > 120 min away 

Ideally within the first 30 min  

Up until 12 – 24 hours in some cases 

tPA: 15 mg IV over 1-2 min followed by 50 mg IV over 30 min followed by 35 mg IV over 60 min (total 100 mg over 1.5 hours) 

TNKase: 30-50 mg IV over 5 sec (dosing is weight based) 

rPA: 10 Units x 2 given 30 min apart 

Any prior ICH 

Ischemic stroke within 3 months (except acute ischemic stroke w/in 4.5 hrs) 

Known structural cerebral vascular lesion (e.g. AVM) or intracranial neoplasm (primary or metastatic) 

Active bleeding or bleeding diatheses (excluding menses) 

Intracranial or intraspinal surgery within 2 months 

For streptokinase, prior tx within the previous 6 months 

Significant closed-head or facial trauma within 3 months 

Suspected aortic dissection 

Severe uncontrolled HTN (unresponsive to emergency therapy) 

ASA: 162 to 325 mg loading dose 

Clopidogrel: 300 mg for ≤75 years old / 75 mg for >75 years old 

UFH bolus & gtt or Enoxaparin or Fondaparinux 

Transfer!  Regardless of hemodynamics or reperfusion success, it is reasonable to still get patients to a PCI-capable center. 

Angiography recommended within the first 24 hours but AVOIDED for the first 2-3 hours after fibrinolytic therapy.