Thrombolysis for Acute Myocardial Infarction: Drug Review

David K. Cundiff

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In This Article

Early Hazard

The meta-analysis of major AMI trials shows an excess of 5/1000 deaths in the thrombolytic treatment groups in the first 12 hours after treatment and no survival advantage in the first 36 hours.[19] If the mechanism of reducing mortality is immediate reperfusion in an IRA, which reduces the loss of myocardium from the infarct, it is difficult to explain why the mortality goes up in the first 12 hours and why the mortality benefit occurred only from 2-35 days after the AMI. Studies suggest that the excess early mortality relates to bleeding complications.[26,27] Strokes mostly due to cerebral hemorrhage occurred in the FTT meta-analysis on days 0-1 in 166 (0.6%) of fibrinolysis patients versus 39 (0.1%) of control patients. This highly statistically significant early excess of mostly fatal central nervous system (CNS) bleeds (4.3 per 1000; SD 0.5) accounts for most of the early hazard.[19]

This issue is quite important, because there are 200,000 heart attack victims in the United States each year who reach the hospital yet die within the first month. Most die during the first 24 hours in hospital.[20]

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