Comidering thrombolysis after acute MI VIEWS & REVIEWS The 'classic' inclusion criteria for thrombolytic therapy may be too restrictive, say Dr VM Figueredo and colleagues from the US.] They believe that this may be one of the reasons that only a sman proportion of potentially eligible patients receive this therapy, despite the well established benefits of prompt thrombolysis after acute Ml. As it stands. when the criteria used in most of the major trials of thrombolytic therapy are used, only about one-third of all patients who present with MI are selected, say Dr Figueredo and colleagues. E>panding inclusion crireria Absolute contraindications to thrombolytic therapy include previous haemorrhagic stroke, head trauma and active internal bleeding. In addition, until more definitive data are available, a decision to initiate thrombolytic therapy for patients with one or more relative contraindications (e.g. a history of cerebrovascular disease or severe hypenension) mu st be made on an individual basis. However, Dr Figueredo and colleagues comment that elderly patients, those with inferior MI or left bundle branch block and those who present late (up to 24 hours) after symptom onset, may benefit from thrombolysis; these groups have traditionally been excluded from such therapy. Use or adjuvants Dr Figueredo and colleagues have also discussed the use of adjuvants to thrombolysis after MI.2 They comment that aspirin is an effective adjunctive agent, and the American College of Cardiology and American Hean Association Task Force recommend that aspirin be used as an adjunct to thrombolytic therapy immediately after MI and then indefinitely. The role of antithrombotic agents, especially heparin, as adjuvant therapy is unclear. In addition, the routine use of immediate cardiac catheterisation with aogioplasty as an adjunctive therapy is not recommended. However, elective angioplasty should be undertaken in patients with recurrent ischaemia after thrombolytic therapy, say Dr Figueredo and colleagues. 1. FiJllen:do VM. et aL 'Thrombolysis after KUIC my<>cardiaI inI'z-ctloa: w ho should be added 10 iDc: lusion citcri.I? Poslgntduale Medicine 96: 30-40. Dec 1994 2. FLJU=do VM, et al. Adjuvants 10 throtnbDl ysil after acute myocardial infarctiun: does addiDg antipla1CLet ageau, IlIIithrombotic 01 lllgioplosry "*" a difl en::occ? I'Oslgadualc Medi cin<: 96: 4S· 54. Dec 19'}4 ... "., .. 5

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Page 1: Considering thrombolysis after acute MI

Comidering thrombolysis after acute MI

VIEWS & REVIEWS

The 'classic' inclusion criteria for thrombolytic therapy may be too restrictive, say Dr VM Figueredo and colleagues from the US. ] They believe that this may be one of the reasons that only a sman proportion of potentially eligible patients receive this therapy, despite the well established benefits of prompt thrombolysis after acute Ml .

As it stands. when the criteria used in most of the major trials of thrombolytic therapy are used, only about one-third of all patients who present with MI are selected, say Dr Figueredo and colleagues.

E>panding inclusion crireria Absolute contraindications to thrombolytic therapy

include previous haemorrhagic stroke, head trauma and active internal bleeding. In addition, until more definitive data are available, a decision to initiate thrombolytic therapy for patients with one or more relative contraindications (e.g. a history of cerebrovascular disease or severe hypenension) must be made on an individual basis.

However, Dr Figueredo and colleagues comment that elderly patients, those with inferior MI or left bundle branch block and those who present late (up to 24 hours) after symptom onset, may benefit from thrombolysis; these groups have traditionally been excluded from such therapy.

Use or adjuvants Dr Figueredo and colleagues have also discussed

the use of adjuvants to thrombolysis after MI.2 They comment that aspirin is an effective adjunctive agent, and the American College of Cardiology and American Hean Association Task Force recommend that aspirin be used as an adjunct to thrombolytic therapy immediately after MI and then indefinitely.

The role of antithrombotic agents, especially heparin, as adjuvant therapy is unclear. In addition, the routine use of immediate cardiac catheterisation with aogioplasty as an adjunctive therapy is not recommended. However, elective angioplasty should be undertaken in patients with recurrent ischaemia after thrombolytic therapy, say Dr Figueredo and colleagues. 1. FiJllen:do VM. et aL 'Thrombolysis after KUIC my<>cardiaI inI'z-ctloa: who should be added 10 iDc:lusion citcri.I? Poslgntduale Medicine 96: 30-40. Dec

1994 2. FLJU=do VM, et al. Adjuvants 10 throtnbDlysil after acute myocardial

infarctiun: does addiDg antipla1CLet ageau, IlIIithrombotic 01 lllgioplosry "*" a diflen::occ? I'Oslgadualc Medicin<: 96: 4S·54. Dec 19'}4 ... " . , ..