Which of the following is an absolute contraindication to thrombolytic therapy?

Active bleeding is considered an absolute contraindication to thrombolytic therapy due to the increased risk of exacerbating the bleeding and causing significant harm to the patient. Thrombolytic agents work by dissolving blood clots, which can already compromise hemostasis in individuals with active bleeding. Administering thrombolytics in such cases could lead to uncontrollable hemorrhage, potentially resulting in severe complications or death.

In contrast, managing conditions like hypertension can be addressed either before or during the initiation of thrombolytic therapy. A low platelet count, while concerning and may increase the risk of bleeding complications, is generally considered a relative contraindication rather than absolute. Similarly, current use of anticoagulants does not universally prevent thrombolytic administration; careful consideration and monitoring can allow for safe use in some contexts where bleeding risk is manageable. Thus, active bleeding clearly stands out as unequivocally prohibitive for thrombolytic therapy.