New challenges for thrombolytic therapy

Article Abstract:

During a myocardial infarction (MI, or heart attack), the blood vessels supplying the heart muscle can become blocked with blood clots. Drugs that dissolve blood clots, thrombolytic agents, can reopen blocked blood vessels, improve heart functioning and reduce mortality. Patients brought into the emergency room suffering from MI are given thrombolytic therapy if they meet certain criteria. The patient must be under 75 years of age, have arrived in the emergency room within four hours of the onset of pain, and have evidence of a myocardial infarction according to an electrocardiogram, which is a record of heart activity. In a survey conducted by Lee et al. reported in the June 15 issue of Annals of Internal Medicine, only 23 percent of patients with myocardial infarction were eligible for thrombolytic therapy. The study was conducted to see which patients experiencing myocardial infarction did not receive therapy and why. The patients that did not meet the criteria for thrombolytic therapy were divided into three groups. One group consisted of patients who should have received therapy but arrived late to the emergency room; another group consisted of patients whose risk-benefit ratio was questionable; and the last group consisted of patients who were clearly not good candidates for therapy. A clear distinction must be made between patients who can benefit from therapy and those who cannot. It is important to provide rapid treatment to all patients who would benefit from therapy. (Consumer Summary produced by Reliance Medical Information, Inc.)

Fibrinolytic agents, Thrombolytic drugs, editorial

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Medical therapy for elderly patients who have had myocardial infarction: too little to the late in life?

Article Abstract:

Recent studies indicate that aspirin and clot-dissolving drugs could be beneficial in elderly patients following a heart attack. It seems appropriate to classify clot-dissolving therapies in persons older than 75 years of age as drugs with uncertain but likely benefit (class IIA). One study showed that patients older than 85 years received clot-dissolving therapies following a heart attack less frequently (7%) than younger patients (33% to 51%). Use of these drugs in the oldest age category increased by 34% over the four-year study period. Another study showed that only 76% of eligible elderly patients left the hospital following a heart attack with a long-term prescription for aspirin. Two studies found that elderly patients taking aspirin after a heart attack had a lower risk of death. Risk factors that doctors should consider before beginning either therapy include body weight, time elapsed since symptoms began, and the risk for bleeding in the brain.

Aged, Elderly, Editorial, Cardiovascular agents

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Care of the patient and management of complications after percutaneous coronary artery interventions

Article Abstract:

Management of the patient and of possible complications following treatment of coronary artery disease is an important aspect of these patientAs care. Coronary artery disease is often treated with balloon angioplasty, a technique to open clogged arteries. Two of the most common complications include acute vessel closure and restenosis, or re-narrowing of the artery. Treatment with anti-clotting drugs, aspirin, and the use of coronary stents, or implants to keep the vessel open, have been shown to reduce these complications. Contrast dyes and X-ray imaging are often used in conjunction with angioplasty and can have serious health effects.

Complications and side effects, Transluminal angioplasty, Balloon angioplasty

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