Emergency thrombolysis in acute myocardial infarction.

Abstract:

:The goal of thrombolytic treatment in acute myocardial infarction is to reestablish permanent blood flow, salvage ischemic myocardium, and reduce mortality. If patency is achieved sufficiently early and is maintained, left ventricular function is preserved and mortality decreases. The recent experience with tissue plasminogen activator and streptokinase in the TIMI I trial is reviewed with specific attention to reperfusion, reocclusion, and bleeding. Other studies concerning left ventricular preservation and mortality are also discussed. Current guidelines for antithrombotic therapy and thrombolysis are discussed. It is extremely important to adequately select patients to avoid side effects. Thorough lysis of the thrombus must be achieved to reduce the risk of rethrombosis. Simultaneous heparin should be administered to treat ongoing thrombosis. Additional antithrombotic therapy with aspirin and acute vasodilation to reduce vasoconstriction probably also decrease the likelihood of reocclusion. Because this treatment predisposes to bleeding, extreme care should be taken to avoid vascular punctures and invasive procedures in these patients. The association of immediate percutaneous transluminal coronary angioplasty has not been beneficial in preventing further events; on the contrary, adverse effects have been associated with this acute intervention.

journal_name

Ann Emerg Med

authors

Heras M,Chesebro JH,Gersh BG,Holmes DR,Mock MB,Fuster V

doi

10.1016/s0196-0644(88)80063-5

subject

Has Abstract

pub_date

1988-11-01 00:00:00

pages

1168-75

issue

11

eissn

0196-0644

issn

1097-6760

pii

S0196-0644(88)80063-5

journal_volume

17

pub_type

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