Document Detail

Late thrombolytic therapy: mechanism of benefit and potential risk among patients treated beyond 6 hours.
MedLine Citation:
PMID:  8269224     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Thrombolytic therapy is the treatment of choice for many patients with myocardial infarction, particularly those presenting to the hospital within 6 hours from symptom onset. Although prompt treatment promises to provide the greatest overall benefit, delayed thrombolysis (possibly beyond a time when myocardial salvage is achieved) may also have a role in current clinical practice. METHODS: A review of the English-language literature was conducted by MEDLINE search. Pertinent references were found as far back as 1912. RESULTS: Results of several nonrandomized clinical studies and one recently completed randomized study (the Late Assessment of Thrombolytic therapy Efficacy [LATE]) suggest that thrombolytic therapy may be beneficial up to 12 hours from the onset of symptoms. The mechanisms of benefit are poorly defined, but they may include myocardial salvage, reduced early infarct zone expansion, improved healing, and decreased ventricular irritability. These mechanisms are not necessarily exclusive of one another. An increased risk of myocardial rupture and thromboembolism may be incurred, limiting the usefulness of treatment with further delay. CONCLUSIONS: Delayed thrombolysis (up to and possibly beyond 12 hours from symptom onset in certain patient subgroups) reduces patient mortality. Despite increasing support, however, many patients, even those seeking medical treatment within 6 hours, are not being given thrombolytic therapy. Further investigation into this area must be undertaken. The Benefits of Late Thrombolysis (BOLT) study should provide much needed information.
R C Becker
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Coronary artery disease     Volume:  4     ISSN:  0954-6928     ISO Abbreviation:  Coron. Artery Dis.     Publication Date:  1993 Mar 
Date Detail:
Created Date:  1994-02-01     Completed Date:  1994-02-01     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  9011445     Medline TA:  Coron Artery Dis     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  293-304     Citation Subset:  IM    
Thrombosis Research Center, University of Massachusetts Medical School, Worcester 01655.
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MeSH Terms
Clinical Trials as Topic
Coronary Angiography / drug effects
Drug Administration Schedule
Fibrinolytic Agents / administration & dosage
Myocardial Infarction / drug therapy*,  mortality,  radiography
Risk Factors
Survival Rate
Thrombolytic Therapy*
Reg. No./Substance:
0/Fibrinolytic Agents

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