Thrombolysis for Acute Myocardial Infarction: Drug Review

David K. Cundiff

Disclosures
In This Article

Conclusion

The theoretical basis of thrombolysis (ie, the open-artery hypothesis) does not account for survival differences in randomized studies. Results of randomized trials of thrombolysis in AMI may have been confounded by lack of uniform use of aspirin, higher control group AMI mortality than prevalent today, and psychological influences due to lack of blinding in some studies. AMI registry statistics do not support the efficacy of thrombolysis in AMI. The NRMI-2 registry suggests that a significant percentage of suspected AMI patients may be inappropriately receiving thrombolytics.

Given the significant morbidity, mortality, and expense of thrombolysis in AMI, an independent analysis of the statistical data of the more than 1 million patients in the NRMI studies should be done, including adjustments for age and all the known poor prognostic factors, in order to better determine whether thrombolysis for AMI improves survival.

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