Bleeding during thrombolytic therapy for acute myocardial infarction: mechanisms and management

Article Abstract:

One of the major causes of myocardial infarction (damage to the heart muscle from lack of blood supply), is a blood clot caught in one of the heart's arteries. Recently, drugs known as thrombolytic agents have become available that rely upon the action of enzymes to dissolve clots, and these are being used with success in the management of myocardial infarction. However, hemorrhage can be a side effect of treatment for clots, and the effects can be severe, as in the case of cerebral hemorrhage, which occurs in 0.2 percent to 0.6 percent of the cases. A review of thrombolytic therapies for myocardial infarction reveals that careful selection of patients and the avoidance of unnecessary procedures can reduce the risk of hemorrhage. Patients with bleeding ulcers, previous stroke or intracranial lesions, and other conditions predisposing towards bleeding should not be treated with thrombolytics. Since more than 70 percent of reported bleeding episodes occur at puncture sites, care should be taken when drawing blood or inserting catheters, and it is recommended that jugular or subclavian sites be avoided. If puncture is unavoidable, extended pressure, at least 15 minutes, should be applied to the site. In addition, other medications being taken should be checked for their effects on clotting. Careful attention to detail can reduce risk, but the internist opting for thrombolytic therapy must be prepared to make quick life-saving decisions when faced with bleeding complications in the myocardial infarct patient. (Consumer Summary produced by Reliance Medical Information, Inc.)

Case studies, Hemorrhage, Dosage and administration, Tissue plasminogen activator, Thrombosis, Streptokinase

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Adjuncts to thrombolysis for myocardial reperfusion

Article Abstract:

Although thrombolytic (clot-dissolving) drugs are effective for treating heart attack victims, their use does not prevent certain related complications, such as persistent occlusion (blockage) of the coronary arteries (that deliver blood to the heart) and hemorrhage (uncontrolled bleeding), a rare but serious problem in such cases. It is possible that other drugs (adjuncts) designed for administration with thrombolytics could improve the clinical outcome. A review is presented of the limitations of thrombolytic therapy as currently practiced, the different types of thrombolytic drugs, and adjunctive drug treatments. These include beta blocking drugs; angiotensin-converting enzyme inhibitors; nitrates; and calcium-channel blocking agents. When blood flow returns to the damaged heart, a type of injury may occur (reperfusion injury) that can be ameliorated by drugs that 'scavenge' (remove) oxygen free-radicals (oxygen molecules with a free electron) or by drugs that inhibit the aggregation of neutrophils (white blood cells that are a source of free radicals). Obstacles to clinical development of many adjuncts to thrombolytic therapy include the large numbers of patients that would be needed to show benefits from their use and the difficulty of determining the best way to evaluate such benefits. Three drugs are recommended for inclusion with thrombolytic therapy: aspirin; intravenous heparin; and beta blockers, when appropriate. (Consumer Summary produced by Reliance Medical Information, Inc.)

Drug therapy, Aspirin, Adrenergic beta blockers, Adrenergic beta-antagonists, Heparin

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Relation of increased arterial blood pressure to mortality and stroke in the context of contemporary thrombolytic therapy for acute myocardial infarction: a randomized trial

Article Abstract:

A patient's blood pressure history may be an important factor in weighing the risk for stroke or death when deciding to use clot-dissolving medication soon after a heart attack. Researchers reviewed the medical records of 41,021 patients who experienced a heart attack and were treated with clot-dissolving medication. Three percent of the patients with a history of high blood pressure subsequently experienced a stroke while only 1.17% of the patients with lower blood pressure experienced a stroke. Patients treated with alteplase were more likely to have a stroke than those given streptokinase but less likely to die.

Evaluation, Patient outcomes, Mortality, Measurement, Stroke (Disease), Stroke, Blood pressure, Thrombolytic therapy, Blood pressure measurement

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