Document Detail


Guidelines for the use of intravenous thrombolytic agents in acute myocardial infarction. Ontario Medical Association Consensus Group on Thrombolytic Therapy.
MedLine Citation:
PMID:  2497946     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
A consensus group convened under the auspices of the Ontario Medical Association produced guidelines for the use of intravenous thrombolytic agents in acute myocardial infarction. The guidelines, updated to December 1988, include the following points. 1) Any hospital that routinely accepts the responsibility for looking after patients with acute myocardial infarction could offer thrombolytic therapy if monitoring facilities are available and if the staff are experienced in the treatment of cardiac rhythm disturbances. 2) Before treatment, all patients must be carefully screened for factors predisposing to hemorrhagic complications. 3) A physician should be clearly designated as responsible for the care of the patient receiving an infusion and be available in the event of problems. 4) For the two approved agents the usual dosages are as follows: streptokinase, 1.5 million units given over 1 hour; and tissue-type plasminogen activator (tPA), 100 mg over 3 hours, delivered as 60 mg in the first hour (of which 6 to 7 mg should be given as a bolus in the first 1 to 2 minutes) and then an infusion of 20 mg/h over the next 2 hours. 5) Intravenous thrombolytics should be considered for any patient with presumed acute myocardial infarction, as suggested by prolonged chest pain or other appropriate symptoms and typical electrocardiographic changes. Expeditious treatment is critical, since myocardial necrosis occurs within hours. 6) Emergency angiography is indicated for patients with hemodynamic compromise and no apparent response to streptokinase or tPA and in those with recurrent chest pain suggestive of acute myocardial infarction despite an apparent response to intravenous thrombolysis. Angiography before discharge is recommended for patients with postinfarction angina or evidence from noninvasive testing of significant residual ischemic risk. 7) There is insufficient evidence to choose between streptokinase and tPA on the basis of the two most important outcome measures: patient survival and myocardial preservation. More conclusive evidence comparing tPA, streptokinase and another promising agent, acylated plasminogen-streptokinase activator complex, will be available in 1989-90.
Authors:
C D Naylor; P W Armstrong
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Publication Detail:
Type:  Journal Article; Research Support, U.S. Gov't, Non-P.H.S.    
Journal Detail:
Title:  CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne     Volume:  140     ISSN:  0820-3946     ISO Abbreviation:  CMAJ     Publication Date:  1989 Jun 
Date Detail:
Created Date:  1989-07-03     Completed Date:  1989-07-03     Revised Date:  2009-11-18    
Medline Journal Info:
Nlm Unique ID:  9711805     Medline TA:  CMAJ     Country:  CANADA    
Other Details:
Languages:  eng     Pagination:  1289-99     Citation Subset:  AIM; IM    
Affiliation:
Thrombolysis Guidelines, Ontario Medical Association, Toronto.
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MeSH Terms
Descriptor/Qualifier:
Angiography
Cost-Benefit Analysis
Hemorrhage / prevention & control
Humans
Injections, Intravenous
Myocardial Infarction / drug therapy*,  radiography
Ontario
Physicians
Risk Factors
Streptokinase / administration & dosage,  adverse effects,  therapeutic use*
Time Factors
Tissue Plasminogen Activator / administration & dosage,  adverse effects,  therapeutic use*
Chemical
Reg. No./Substance:
EC 3.4.-/Streptokinase; EC 3.4.21.68/Tissue Plasminogen Activator
Comments/Corrections
Erratum In:
Can Med Assoc J 1989 Jul 15;141(2):104

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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