[Initial experiences with thrombolysis in Swiss hospitals. Synopsis of a round-table discussion].
Thrombolytic therapy of acute myocardial infarction (AMI) has resulted in significant reduction of mortality, limitation of infarct size and preservation of left ventricular function. Among the panelists there was consensus with respect to the following recommendations for efficient thrombolytic therapy of AMI: the prehospital phase should be considerably shortened, especially by reducing patient delay. This can be achieved by rendering patients aware of symptoms of AMI and the need for immediate hospitalization on their occurrence. After contraindications have been ruled out, intravenous thrombolysis should be started in every case where the time elapsed since the onset of pain is not greater than 3 hours. In patients with large infarctions intravenous thrombolysis is indicated up to 6 hours after onset of pain. Accompanying medication should include heparinization and administration of aspirin. When reperfusion is achieved the patient should be monitored for recurrence of ischemia. Regardless of symptoms recurrence of ischemia requires immediate coronary arteriography with a view to revascularization by PTCA or bypass surgery. Patients without recurrence of spontaneous ischemia should undergo ergometric stress testing before leaving the hospital. Exercise-induced angina or ST segment depression are strong indications for coronary arteriography.
Krayenbühl
H P
HP
Medizinische Poliklinik, Universitätsspital, Zürich.
Ziegler
H
H
Moccetti
T
T
Ritz
R
R
D000208:Acute Disease; D000367:Age Factors; D000790:Angiocardiography; D003365:Costs and Cost Analysis; D005069:Evaluation Studies as Topic; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006801:Humans; D009203:Myocardial Infarction / Q000188:drug therapy* / Q000191:economics; D011379:Prognosis; D013557:Switzerland; D013997:Time Factors
D005343:Fibrinolytic Agents
Erste Erfahrungen mit der Thrombolyse an Schweizer Spitälern. Zusammenfassung des Rundtischgespräches.