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Refining the risk‐benefit equation for thrombolysis: How to identify the low risk patient before administering thrombolytic therapy
Author(s) -
Parsons Richard,
Thompson Peter,
Nidorf Mark,
Hobbs Michael,
Jamrozik Konrad
Publication year - 1998
Publication title -
australian and new zealand journal of medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.596
H-Index - 70
eISSN - 1445-5994
pISSN - 0004-8291
DOI - 10.1111/j.1445-5994.1998.tb02104.x
Subject(s) - medicine , thrombolysis , myocardial infarction , infarction , intensive care medicine , fibrinolytic agent , cardiology , tissue plasminogen activator
In view of the relative risk of intracranial haemorrhage and major bleeding with thrombolytic therapy, it is important to identify as early as possible the low risk patient who may not have a net clinical benefit from thrombolysis in the setting of acute myocardial infarction. An analysis of 5434 hospital‐treated patients with myocardial infarction in the Perth MONICA study showed that age below 60 and absence of previous infarction or diabetes, shock, pulmonary oedema, cardiac arrest and Q‐wave or left bundle branch block on the initial ECG identified a large group of patients with a 28 day mortality of only 1 %, and one year mortality of only 2%. Identification of baseline risk in this way helps refine the risk‐benefit equation for thrombolytic therapy, and may help avoid unnecessary use of thrombolysis in those unlikely to benefit.