Thrombolytic therapy of patients with acute myocardial infarction

Article Abstract:

A report by Naylor and Jaglal in the August 8, 1990 issue of The Journal of the American Medical Association describes the results of a meta-analysis performed to assess whether there was an increase in revascularization surgical procedures among patients who received thrombolytic drug therapy after an acute myocardial infarction (MI or heart attack). Acute myocardial infarctions occur as the result of a thrombus (blood clot) occluding a coronary artery, which supplies blood to the heart muscle. Most likely the thrombus develops over a ruptured atherosclerotic plaque in a damaged blood vessel wall. After evaluating seven randomized control trials of thrombolytic therapy with either tissue plasminogen activator or streptokinase, these researchers found that there was a relative increase in revascularization procedures of about 80 percent within the first six weeks after MI in patients who received this therapy. It is of no surprise that patients who require thrombolytic therapy may also require revascularization surgery to treat the underlying damaged vessel. What is not clear is whether there is an advantage to using routine angiography to examine the vessels of these patients, instead of relying on clinically persistent ischemia, or ischemia on exercise testing prior to discharge or at a first follow-up visit as standard criteria for surgical referral. The increase in revascularization procedures may be a reflection of the increase in heart attack survival as a result of thrombolytic therapy. (Consumer Summary produced by Reliance Medical Information, Inc.)

Causes of, Physiological aspects, Surgery, Thrombosis, Coronary arteries, editorial

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An analysis of time delays preceding thrombolysis for acute myocardial infarction

Article Abstract:

Treatment of acute myocardial infarction (heart attack) with thrombolytic therapy is known to be most effective if administered within the first three hours after the onset of symptoms. If administered promptly, left ventricular function may be more quickly restored and may prevent patient mortality. Researchers studied the records of 236 patients admitted for acute myocardial infarction who were subsequently given treatment with intravenous thrombolytic therapy. The data was complied by the University of Minnesota Thrombolysis in Myocardial Infarction II Clinical Unit from four area hospitals. The time delays that accounted for each phase of initial treatment for these patients were recorded. It was hoped that this data would provide helpful information in the formulation of guidelines to ensure faster delivery of cardiac emergency services. Part of the initial treatment delays were found to be caused by the patient's unwillingness to seek treatment. Once the patient arrived in the emergency room, he waited an average of 19.9 minutes before having an electrocardiogram and another 70 minutes before the initiation of thrombolytic treatment. The average time that elapsed from the onset of the patient's symptoms to the commencement of therapy was 153 minutes. These periods of treatment delay within the hospital were considered significant and efforts to maximize the efforts of cardiac teams is recommended.

Care and treatment, Usage, Coronary heart disease, Dosage and administration, Tissue plasminogen activator, Time and motion study, Time and motion studies

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Bolus Fibrinolytic Therapy in Acute Myocardial Infarction

Article Abstract:

Reteplase, lanoteplase, and tenecteplase are as effective as tPA for treating heart attack patients and are more convenient because they can be given all at once instead of as an intravenous infusion. However, lanoteplase is more likely than the other two drugs to cause intracranial hemorrhage.

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