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Debate: Should the elderly receive thrombolytic therapy or primary angioplasty?

Thrombolysis and primary angioplasty are both recommended reperfusion strategies for elderly patients presenting with myocardial infarction (MI). Primary angioplasty is most beneficial in high-risk patients. While the elderly have a high absolute risk of dying or developing complications after MI, t...

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Detalles Bibliográficos
Autor principal: White, Harvey D
Formato: Texto
Lenguaje:English
Publicado: BioMed Central 2000
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC59616/
https://www.ncbi.nlm.nih.gov/pubmed/11714431
http://dx.doi.org/10.1186/cvm-1-3-150
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author White, Harvey D
author_facet White, Harvey D
author_sort White, Harvey D
collection PubMed
description Thrombolysis and primary angioplasty are both recommended reperfusion strategies for elderly patients presenting with myocardial infarction (MI). Primary angioplasty is most beneficial in high-risk patients. While the elderly have a high absolute risk of dying or developing complications after MI, they also have an increased risk of intracranial haemorrhage if they are given thrombolytic therapy. It could therefore be reasonably argued that primary angioplasty is the reperfusion strategy of choice in the elderly. However, primary angioplasty has not been shown to have a greater relative benefit than thrombolytic therapy in the elderly. Recent data from the Fibrinolytic Therapy Trialists' (FTT) Collaborative Group show that thrombolytic therapy significantly reduces mortality compared with control treatment in patients over 75 years of age presenting within 12 h of symptom onset, with ST-segment elevation or bundle branch block. Future advances in adjunctive therapies may improve myocyte perfusion and hence the outcomes achieved by both invasive and noninvasive reperfusion strategies. Better thrombolytic regimens incorporating adjunctive agents such as bivalirudin may reduce the risk of intracranial haemorrhage. Few hospitals can provide a 24-h primary angioplasty service with door-to-balloon times consistently less than 90 min, and thrombolytic therapy is therefore a far more practical option in most instances.
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spelling pubmed-596162001-11-06 Debate: Should the elderly receive thrombolytic therapy or primary angioplasty? White, Harvey D Curr Control Trials Cardiovasc Med Commentary Thrombolysis and primary angioplasty are both recommended reperfusion strategies for elderly patients presenting with myocardial infarction (MI). Primary angioplasty is most beneficial in high-risk patients. While the elderly have a high absolute risk of dying or developing complications after MI, they also have an increased risk of intracranial haemorrhage if they are given thrombolytic therapy. It could therefore be reasonably argued that primary angioplasty is the reperfusion strategy of choice in the elderly. However, primary angioplasty has not been shown to have a greater relative benefit than thrombolytic therapy in the elderly. Recent data from the Fibrinolytic Therapy Trialists' (FTT) Collaborative Group show that thrombolytic therapy significantly reduces mortality compared with control treatment in patients over 75 years of age presenting within 12 h of symptom onset, with ST-segment elevation or bundle branch block. Future advances in adjunctive therapies may improve myocyte perfusion and hence the outcomes achieved by both invasive and noninvasive reperfusion strategies. Better thrombolytic regimens incorporating adjunctive agents such as bivalirudin may reduce the risk of intracranial haemorrhage. Few hospitals can provide a 24-h primary angioplasty service with door-to-balloon times consistently less than 90 min, and thrombolytic therapy is therefore a far more practical option in most instances. BioMed Central 2000 2000-12-04 /pmc/articles/PMC59616/ /pubmed/11714431 http://dx.doi.org/10.1186/cvm-1-3-150 Text en Copyright © 2000 Current Controlled Trials Ltd
spellingShingle Commentary
White, Harvey D
Debate: Should the elderly receive thrombolytic therapy or primary angioplasty?
title Debate: Should the elderly receive thrombolytic therapy or primary angioplasty?
title_full Debate: Should the elderly receive thrombolytic therapy or primary angioplasty?
title_fullStr Debate: Should the elderly receive thrombolytic therapy or primary angioplasty?
title_full_unstemmed Debate: Should the elderly receive thrombolytic therapy or primary angioplasty?
title_short Debate: Should the elderly receive thrombolytic therapy or primary angioplasty?
title_sort debate: should the elderly receive thrombolytic therapy or primary angioplasty?
topic Commentary
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC59616/
https://www.ncbi.nlm.nih.gov/pubmed/11714431
http://dx.doi.org/10.1186/cvm-1-3-150
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