Thrombolysis: early benefit, bolus agents and bleeding risk
THE CONTEXT
Continuing the discussion of thrombolysis for ST elevation myocardial infarction, this passage describes treatment timing, practical agents, bleeding hazards and circumstances for emergency PCI.
Timing and administration
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The benefit of thrombolysis is greatest within the first 12 hours, especially within the first 2 hours.
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Tenecteplase and reteplase are analogues of human tissue plasminogen activator.
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These agents can be administered as an intravenous bolus, permitting prompt treatment in the emergency department or before hospital arrival.
Bleeding hazards
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Bleeding is the major hazard of thrombolysis.
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Cerebral haemorrhage causes 4 additional strokes per 1000 treated patients. Other major bleeding occurs in 0.5–1%.
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Thrombolysis should be withheld when there is a significant risk of serious bleeding.
Emergency PCI
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Emergency PCI may be considered when thrombolysis is contraindicated or fails to restore coronary arterial reperfusion, particularly when cardiogenic shock is present.