[Possibilities and limitations of thrombolysis. Benefits and risk in acute myocardial infarct, lung embolism, pelvic and leg vein thrombosis as well as cerebrovascular accidents].
The indications for thrombolytic therapy in acute myocardial infarction, pulmonary embolism, deep venous thrombosis and ischemic stroke are reviewed on the basis of a risk-benefit analysis. There is strong evidence that thrombolysis benefits the majority of patients with acute myocardial infarction. Nevertheless, the overall proportion of patients actually receiving this therapy is disappointingly low (10-30%). Efforts are mainly required in minimizing delays in initiating thrombolysis (patient, doctor, in-hospital) and in providing thrombolytic therapy to an extended proportion of qualifying patients. This implies that many traditional but inappropriate exclusion criteria (e.g. age, presentation 6 to 12 hours after onset of symptoms, hypertension, reinfarction, brief cardiopulmonary resuscitation) are unfounded. Depending on duration of symptoms, infarct localization and age, we favor a differentiated thrombolytic regimen with rt-PA or streptokinase. In contrast to acute myocardial infarction, the risk-benefit ratio for the other thrombotic disorders discussed favours thrombolytic therapy only in a minority of carefully selected patients.
Flury
G
G
Departement für Innere Medizin, Universitätsspital, Zürich.
D000368:Aged; D000369:Aged, 80 and over; D002561:Cerebrovascular Disorders / Q000188:drug therapy; D000075202:Contraindications; D006801:Humans; D007866:Leg / Q000098:blood supply; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy*; D011655:Pulmonary Embolism / Q000188:drug therapy*; D012307:Risk Factors; D015912:Thrombolytic Therapy; D013927:Thrombosis / Q000188:drug therapy*; D013997:Time Factors
Möglichkeiten und Grenzen der Thrombolyse. Nutzen und Risiko bei akutem Myokardinfarkt, Lungenembolie, Becken- und Beinvenenthrombosen sowie zerebrovaskulärem Insult.