Positive thinking on thrombolytics in AMI and stroke
Recent large studies have documented the beneficial effects of thrombolytics in the management of acute myocardial infarction (AMI). However, there is concern over the risk of bleeding, particularly intracranial bleeding, which is presumed to be enhanced by the non-specific thrombolytic activity of the agents used in AMI.
Few studies have been able to demonstrate an increase in haemorrhagic strokes in thrombolytic recipients over more conventionally managed control patients, and those that have are balanced by those which show an overall reduction in studies (haemorrhagic + ischaemic) in thrombolysis recipients vs controls. Further, the results of some studies suggest that patient selection can reduce the risk of intracranial haemorrhage by excluding patients with a history of cerebrovascular disease from thrombolytic therapy.
'The potential benefits of prompt administration of
thrombolytic agents are undisputable. The risk of
deviating these benefits by failure to treat
appropriate candidates clearly exceeds the risk of therapy.'
T1efenbrunn AJ, Ludbrook PA. Coronary thrombolysis it's worth the nsk
Journal of the Amencan Med1ca1 Association 261 21072108. 14 Apr
4 INPHARMA"' 6 May 1989 0756-2703/89/0506-0004/0$07.00/0 ADIS Press