Coronary thrombolysis for the elderly?

Article Abstract:

Current evidence suggests that thrombolytics, or agents that break down blood clots, can decrease the short-term death rate in older heart attack patients. However, there is limited knowledge about the long-term effects of thrombolytic therapy on survival of elderly patients. Elderly heart attack patients have a small increase in risk of bleeding within the brain, which must be considered because thrombolytics may foster such bleeding. Although thrombolytic therapy can result in revascularization, or resumption of blood flow to the heart, the relationship between thrombolytic therapy and revascularization requires further study in the elderly population. Studies examining the benefits of thrombolytic treatment in the oldest patients, those aged 85 years or older, are especially needed, since this portion of the general population is growing. Most studies examining thrombolytic therapy have involved, as the oldest age group, persons no older than 75 years. An appropriate study of the effects of thrombolytic treatment on the survival and function of heart attack patients older than 75 years is unlikely, because it would require 4,000 subjects. The clinician's choice of treatment should be based on scientific data concerning risks and benefits of the treatment. However, the decision to start thrombolytic treatment in elderly patients experiencing heart attack may be difficult due to complex clinical and ethical concerns. Age should not be a major determining factor in this decision, and elderly heart attack patients without contraindication should be considered for thrombolytic treatment. (Consumer Summary produced by Reliance Medical Information, Inc.)

Usage, Demographic aspects

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Risk for intracranial hemorrhage after tissue plasminogen activator treatment for acute myocardial infarction

Article Abstract:

Bleeding in the brain is a rare but potentially fatal complication of thrombolytic therapy for heart attack. Tissue plasminogen activator (tPA) is a clot-dissolving drug used in stroke and heart attack to restore blood flow to the brain or heart. Researchers evaluated the adverse effects of tPA thrombolysis in 71,073 patients with a serious heart attack. Intracranial hemorrhage developed in 0.88% of patients, leading to death in 53% of these patients. One-fourth of patients who developed bleeding in the brain left the hospital with some remaining neurological injury.

Complications and side effects, Risk factors, Stroke (Disease), Stroke, Brain, Brain hemorrhage, Tissue plasminogen activator, Thrombolytic therapy

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Coronary thrombolysis for the elderly: is clinical practice really lagging behind evidence of benefit?

Article Abstract:

Many elderly patients admitted to a hospital for heart attack are not receiving thrombolytic drugs that could improve their survival. Thrombolytic drugs are drugs that break up the blood clots that cause most heart attacks. Studies have shown that many elderly patients who are eligible for thrombolytic drugs are not receiving them, but the percentage who do has increased since 1991. However, these drugs can increase the risk of cerebral hemorrhage and some studies show they do not necessarily reduce mortality rates in the elderly.

Care and treatment, Editorial

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