Inpharma 1376 - 1 Mar 2003
Thrombolytics: CPR should not bea contraindication
Thrombolytic treatment should not be withheld inpatients who have experienced a cardiac arrest andreceived CPR as a result of an acute myocardialinfarction, according to researchers from Austria.1
In this retrospective study, data were collected from265 such patients who received thrombolytic treatment(n = 132) or no such therapy during their hospitaladmission. The decision to administer alteplase[Actilyse] was left to the discretion of the admittingemergency physician.
Major bleeding complications occurred in 13 patients(10%) who received thrombolytic treatment and 7 (5%)who did not receive such therapy; the between-groupdifference was not statistically significant. No patientsdied as a result of a CPR-related haemorrhagic event.Prolonged CPR was not associated with an increase inthe risk of a major bleeding complication, irrespective ofwhether thrombolytic treatment was administered.Surprisingly, the 6-month survival rate was only slightlybetter in patients who received thrombolytic treatment,compared with those who did not, after adjusting forbaseline factors.
The researchers conclude that thrombolytic treatmentshould not be withheld in patients who have receivedCPR, unless they have other contraindications, as mostcomplications are not life-threatening and can be easilymanaged.
In an accompanying editorial, Drs BW Bottiger and FSpohr from the University of Heidelberg, Germany, saythat the recommendation to withhold thrombolytictreatment in patients who have received CPR has neverbeen based on conclusive scientific evidence.2 Althoughthrombolysis can cause potentially fatal haemorrhagicevents, they say that there is "no evidence that severebleeding events occur far more often when thrombolysisis combined with cardiocompressions". The findings ofthis study support the view that the risk of CPR-associated bleeding complications do not outweigh thepotential benefits of thrombolysis in acute myocardialinfarction, conclude Drs Bottiger and Spohr.1. Kurkciyan I, et al. Major bleeding complications after cardiopulmonary
resuscitation: impact of thrombolytic treatment. Journal of Internal Medicine253: 128-135, Feb 2003.
2. Bottiger BW, et al. The risk of thrombolysis in association withcardiopulmonary resuscitation: no reason to withhold this causal and effectivetherapy. Journal of Internal Medicine 253: 99-101, Feb 2003.
Inpharma 1 Mar 2003 No. 13761173-8324/10/1376-0001/$14.95 Adis 2010 Springer International Publishing AG. All rights reserved