Abstract
Thrombolytic therapy is a huge advance in the management of acute myocardial infarction (AMI). The results of large clinical trials over the past 9 years have unequivocally demonstrated its benefit: of every 1000 patients treated 30 will be saved, at a cost of two cases of nonfatal cerebral hemorrhage and seven of noncerebral major hemorrhage. The concurrent use of acetylsalicylic acid increases the benefit of thrombolytic therapy. Sales figures for thrombolytic agents indicate that their use in Canada is less than optimal and lags behind that in several European countries. Major educational efforts are needed to promote awareness of the efficacy of thrombolytic therapy and of optimal approaches for maximizing its potential benefit for patients with AMI.
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Selected References
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- Bleich S. D., Nichols T. C., Schumacher R. R., Cooke D. H., Tate D. A., Teichman S. L. Effect of heparin on coronary arterial patency after thrombolysis with tissue plasminogen activator in acute myocardial infarction. Am J Cardiol. 1990 Dec 15;66(20):1412–1417. doi: 10.1016/0002-9149(90)90525-6. [DOI] [PubMed] [Google Scholar]
- Cairns J. A. Coronary thrombolysis: mortality trials. Can J Cardiol. 1993 Jul-Aug;9(6):490–497. [PubMed] [Google Scholar]
- Cairns J. A., Fuster V., Kennedy J. W. Coronary thrombolysis. Chest. 1992 Oct;102(4 Suppl):482S–507S. doi: 10.1378/chest.102.4_supplement.482s. [DOI] [PubMed] [Google Scholar]
- Cairns J., Armstrong P., Belenkie I., Hirsh J., Johnstone D., Knudtson M., Lemieux M., Massel D., Naylor D., Roy L. Canadian Consensus Conference on Coronary Thrombolysis--1994 update. Can J Cardiol. 1994 Jun;10(5):517–521. [PubMed] [Google Scholar]
- Hirsch J. Mechanisms of action of thrombolytic drugs. Can J Cardiol. 1993 Jul-Aug;9(6):485–486. [PubMed] [Google Scholar]
- Ketley D., Woods K. L. Impact of clinical trials on clinical practice: example of thrombolysis for acute myocardial infarction. Lancet. 1993 Oct 9;342(8876):891–894. doi: 10.1016/0140-6736(93)91945-i. [DOI] [PubMed] [Google Scholar]
- Knudtson M. Coronary thrombolysis: adjuvant coronary angioplasty. Can J Cardiol. 1993 Jul-Aug;9(6):528–536. [PubMed] [Google Scholar]
- Lancet D. Olfaction. Exclusive receptors. Nature. 1994 Nov 24;372(6504):321–322. doi: 10.1038/372321a0. [DOI] [PubMed] [Google Scholar]
- Naylor C. D., Bronskill S., Goel V. Cost-effectiveness of intravenous thrombolytic drugs for acute myocardial infarction. Can J Cardiol. 1993 Jul-Aug;9(6):553–558. [PubMed] [Google Scholar]
- Pell A. C., Miller H. C., Robertson C. E., Fox K. A. Effect of "fast track" admission for acute myocardial infarction on delay to thrombolysis. BMJ. 1992 Jan 11;304(6819):83–87. doi: 10.1136/bmj.304.6819.83. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Theroux P., Roy L. Coronary thrombolysis: adjuvant medical therapy. Can J Cardiol. 1993 Jul-Aug;9(6):524–528. [PubMed] [Google Scholar]
- Wilcox R. G., von der Lippe G., Olsson C. G., Jensen G., Skene A. M., Hampton J. R. Trial of tissue plasminogen activator for mortality reduction in acute myocardial infarction. Anglo-Scandinavian Study of Early Thrombolysis (ASSET). Lancet. 1988 Sep 3;2(8610):525–530. doi: 10.1016/s0140-6736(88)92656-6. [DOI] [PubMed] [Google Scholar]
- Yusuf S., Collins R., Peto R., Furberg C., Stampfer M. J., Goldhaber S. Z., Hennekens C. H. Intravenous and intracoronary fibrinolytic therapy in acute myocardial infarction: overview of results on mortality, reinfarction and side-effects from 33 randomized controlled trials. Eur Heart J. 1985 Jul;6(7):556–585. doi: 10.1093/oxfordjournals.eurheartj.a061905. [DOI] [PubMed] [Google Scholar]
