Which of the following is an absolute contraindication for fibrinolytics in STEMI?

In the context of STEMI (ST-Elevation Myocardial Infarction) management, the use of fibrinolytics is critical for dissolving clots. However, certain conditions pose significant risks when fibrinolytics are administered.

Having a known cerebral vascular lesion indicates a pre-existing condition that could worsen with the introduction of fibrinolytic agents. This is because fibrinolytics can induce bleeding, and any cerebral vascular lesion increases the risk of hemorrhagic complications, potentially leading to a life-threatening intracranial hemorrhage. Therefore, the presence of this condition is considered an absolute contraindication for fibrinolytic therapy, as it heightens the risk to a level where the potential benefits of timely treatment cannot outweigh the dangers involved.

Other conditions mentioned, such as active peptic ulcer disease and severe uncontrolled hypertension, are significant risk factors but may not be absolute contraindications depending on the clinical scenario. They could be managed or mitigated in certain situations. History of chronic hypertension, while it can contribute to an increased risk of complications, does not represent an immediate or direct threat equivalent to that posed by a known cerebral vascular lesion.