The current status of thrombolytic therapy

Philip Aylward

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Fibrinolytic therapy substantially reduces mortality from acute myocardial infarction. Patient selection is, however, important. The patient must present within 12 hours of the onset of ischaemic symptoms, have definite ECG changes of ST elevation or left bundle branch block and no contraindications. The major contraindications are those for risk of an intracerebral bleed, recent stroke, intracranial tumour or risk of a major systemic bleed. Age and hypertension are not contraindications but may modify the regimen used. Heparin is required with recombinant tissue plasminogen activator but is optional with streptokinase. The recent COBALT trial suggests that the accelerated weight related t-PA regimen given over 90 minutes in more satisfactory than double bolus t-PA. However, in patients under 75 years of age, the two regimens were equivalent. For patients suffering acute myocardial infarction, practitioners should now individualise choice of therapy, rather than give the same cocktail to all patients. The choice of regimen will depend on the cardiac risk, the stroke risk, the bleeding risk and the cost.

LanguageEnglish
Pages501-503
Number of pages3
JournalAustralian and New Zealand journal of medicine
Volume27
Issue number4
DOIs
Publication statusPublished - 1 Jan 1997

Keywords

  • COBALT
  • Clinical trials
  • Coronary thrombosis
  • Heparin
  • Thrombolysis

ASJC Scopus subject areas

  • Internal Medicine

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