Patient Selection for Thrombolytic Therapy for Evolving Myocardial Infarction
“ONE REGIMEN FITS ALL?” Initially, investigators recommended a “standard” thrombolytic regimen for all patients with evolving myocardial infarction ,. Although thrombolytic therapy will be beneficial in most patients with evolving myocardial infarction, the overall results of clinical trials are not directly applicable to all individual patients ,. Complying with the inclusion criteria of the thrombolysis trials is not enough because patients included in the trials are heterogeneous regarding their profile of both cardiac and bleeding risks. Let us focus on a patient with an evolving myocardial infarction who is at very low risk for death without thrombolytic therapy for example, 1-2% in the first year. He will probably not benefit from thrombolytic therapy because mortality reduction is maximally 0.5-1 per hundred patients treated and is likely to be offset by intracranial bleeding in 0.5-2% patients, 50% of which are lethal [5, 6, 7, 8, 9]. Therefore, careful weighing of the benefits and risks in individual patients is necessary, especially in patients with risk factors for intracerebral bleeding with little expected benefit from thrombolytic therapy.
KeywordsAcute Myocardial Infarction Thrombolytic Therapy Bleeding Risk Suspected Acute Myocardial Infarction Intravenous Tissue Plasminogen Activator
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