18 THERAPY Thrombolysis beneficial in some patients with MI and prior stroke? Thrombolytics may be beneficial in selected patients with acute myocardial infarction (MI) and a history of a cerebrovascular event, say researchers in Israel. They add that such patients should not be categorically excluded from thrombolytic therapy. The researchers explain that prior stroke has been considered a contraindication to thrombolytic therapy for acute MI, because of the risk of intracranial haemorrhage. Patient characteristics The Israeli Thrombolytic National Survey evaluated data from 2012 patients with acute MI who were admitted to a coronary care unit during two 2-month periods in 1992 and 1994. 1897 patients had no prior cerebrovascular event and 873 (46%) of them received thrombolytic therapy. 115 (6%) patients had had a prior cerebrovascular event* and these patients were on average 5 years older than those with no prior event; 29 (25%) of the patients in this group received thrombolytic therapy. Thrombolytic therapy was most commonly streptokinase or aJteplase. Patients with a nonrecent cerebrovascular event who receive thrombolytic therapy for acute MI 'tend to have a better outcome than counterparts who do not receive this therapy' , say the researchers. The survey revealed that none of the 29 thrombolysis recipients who had a history of cerebrovascular events had an intracranial haemorrhage after their acute MI was treated. In addition, the I-year mortality rate in this group was almost half of that seen in a comparator group of 46 patients who did not receive thrombolysis for acute MI, primarily because of their history of a prior cerebrovascular event (I -year mortality rates of 18 and 33%, respectively). Careful individual assessment should guide decisions regarding the potential risks versus benefits of thrombolytic therapy, say the researchers. To this end, they suggest that future studies should include data on the type and severity of prior cerebrovascular events in patients admitted with acute MI. • stroke or traruient ischaemic aI1aCk. Tanne D. GooIieb s. Caspi A, Israeli Thrombolytic National Survey Group. Treatment and outcome of patients with acute myocardial infarction and prior cerebrovascular events in the thrombolytic era: the Israeli Thrombolytic National Survey. Arcb.ives of Internal Medicine 158: 60 1-{i()6. 23 Mac 1998 ''''''''921!' Inpharma-g May 1l1li8 No. 1136 1173-832419811136-000181$01.00° Adl. International Limited 1l1li8. All rlghte

Thrombolysis beneficial in some patients with MI and prior stroke?

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18 THERAPY

Thrombolysis beneficial in some patients with MI and prior stroke?

Thrombolytics may be beneficial in selected patients with acute myocardial infarction (MI) and a history of a cerebrovascular event, say researchers in Israel. They add that such patients should not be categorically excluded from thrombolytic therapy. The researchers explain that prior stroke has been considered a contraindication to thrombolytic therapy for acute MI, because of the risk of intracranial haemorrhage.

Patient characteristics The Israeli Thrombolytic National Survey

evaluated data from 2012 patients with acute MI who were admitted to a coronary care unit during two 2-month periods in 1992 and 1994. 1897 patients had no prior cerebrovascular event and 873 (46%) of them received thrombolytic therapy. 115 (6%) patients had had a prior cerebrovascular event* and these patients were on average 5 years older than those with no prior event; 29 (25%) of the patients in this group received thrombolytic therapy. Thrombolytic therapy was most commonly streptokinase or aJteplase.

Patients with a nonrecent cerebrovascular event who receive thrombolytic therapy for acute MI 'tend to have a better outcome than counterparts who do not receive this therapy' , say the researchers.

The survey revealed that none of the 29 thrombolysis recipients who had a history of cerebrovascular events had an intracranial haemorrhage after their acute MI was treated. In addition, the I-year mortality rate in this group was almost half of that seen in a comparator group of 46 patients who did not receive thrombolysis for acute MI, primarily because of their history of a prior cerebrovascular event (I -year mortality rates of 18 and 33%, respectively).

Careful individual assessment should guide decisions regarding the potential risks versus benefits of thrombolytic therapy, say the researchers . To this end, they suggest that future studies should include data on the type and severity of prior cerebrovascular events in patients admitted with acute MI.

• stroke or traruient ischaemic aI1aCk. Tanne D. GooIieb s. Caspi A, Israeli Thrombolytic National Survey Group.

Treatment and outcome of patients with acute myocardial infarction and prior cerebrovascular events in the thrombolytic era: the Israeli Thrombolytic National Survey. Arcb.ives of Internal Medicine 158: 60 1-{i()6. 23 Mac 1998

''''''''921!'

Inpharma-g May 1l1li8 No. 1136 1173-832419811136-000181$01.00° Adl. International Limited 1l1li8. All rlghte ~