What is the role of prehospital thrombolysis in the treatment of acute coronary syndrome (ACS)?

Updated: Sep 30, 2020
  • Author: David L Coven, MD, PhD; Chief Editor: Eric H Yang, MD  more...
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Prehospital thrombolysis allows eligible patients to receive thrombolysis 30-60 minutes sooner than if treatment were given in the ED; however, prehospital thrombolysis is still under investigation and has not become a trend, as a result of unproven benefit and an increase in the availability of PCI in many medical centers as an alternative to thrombolysis for STEMI.

The Remodeling With Erythropoietin After Large Myocardial Infarction (REVEAL) trial evaluated the safety and efficacy of a single intravenous bolus of epoetin alfa in patients with STEMI who had successful reperfusion with primary or rescue PCI. [99] A single intravenous bolus of epoetin alfa within 4 hours of PCI did not reduce infarct size and was associated with higher rates of adverse cardiovascular events.

Although PCI is the preferred treatment for STEMI, the distance to primary PCI centers and the inherent time delay in delivering primary PCI limits widespread use of this treatment. Prehospital electrocardiographic (ECG) diagnosis and direct referral for primary PCI enables patients with STEMI living far from a PCI center to achieve a system delay comparable to patients who are closer to a PCI center. [100]

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