Reactions 686 - 31 Jan 1998

Diabetic retinopathy not acontraindication for thrombolyticsPatients with diabetes mellitus are no more likely than

patients without diabetes mellitus to develop ocularhaemorrhage during thrombolytic therapy for acutemyocardial infarction, according to an analysis of datafrom the Global Utilisation of Streptokinase and t-Pa[alteplase] for Occluded Coronary Arteries* (GUSTO-1)trial.

For 99.7% of patients (n = 40 899) in the GUSTO-1trial, information was available about history of diabetesmellitus and ocular bleeding. 6011 patients in the trialhad diabetes mellitus and, of these, an estimated 2000had nonproliferative retinopathy and 300 hadproliferative retinopathy.

Ocular haemorrhage in 12 patientsOcular haemorrhage occurred in 12 patients in the

GUSTO-1 trial; 11 cases of extraocular and 1 case ofintraocular haemorrhage. None of the patients withdiabetes mellitus developed intraocular haemorrhageand only 1 patient with diabetes mellitus developed anextraocular haemorrhage. There was no difference in therate of ocular haemorrhage in patients with diabetesmellitus compared with patients who did not havediabetes mellitus; odds ratio 0.53 (95% CI 0.07–4.09).The upper 95% confidence interval for the incidence ofintraocular haemorrhage in patients with and withoutdiabetes mellitus, was 0.05% and 0.006%, respectively.

The researchers conclude that diabetic retinopathyshould not be considered a contraindication to the useof thrombolytic therapy for the treatment of acutemyocardial infarction.* Patients received 1 of 4 regimens involving streptokinase, alteplase,heparin and aspirin.

Mahaffey KW, et al. Diabetic retinopathy should not be a contraindication tothrombolytic therapy for acute myocardial infarction: review of ocular hemorrhageincidence and location in the GUSTO-I trial. Journal of the American College ofCardiology 30: 1606-1610, Dec 1997 800656705

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Reactions 31 Jan 1998 No. 6860114-9954/10/0686-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved