Thrombolytic Therapy in Acute Myocardial Infarction

The administration of thrombolytic agents and aspirin is now a well-established treatment package for selected patients with acute myocardial infarction [1, 2]. When successful, thrombolysis permits reperfusion of previously occluded coronary arteries, salvages ischemic myocardium, prevents left ventricular dysfunction, and enhances both early and late survival (Fig. 1). The overall incidence of complications or adverse reactions is very low, i.e., the benefit-risk ratio is favourable. Hemorrhage is the major complication, and intracranial hemorrhage is the most catastrophic form of hemorrhage following coronary artery thrombolysis. However, the results of large-scale trials show that the overall risk of stroke (of any type) is reduced after thrombolytic therapy (Table 1). In the prethrombolytic era, approximately 3% of patients with acute myocardial infarction developed a stroke either concurrently with the infarction or during the same hospitalization [3, 4]. The dominant form of stroke was a nonhemorrhagic infarct arising from thromboembolic disease, often in patients with atrial arrhythmias, or a large anterior wall infarction. The stroke rate in patients treated with thrombolytic therapy is l%–2% and nonhemorrhagic stroke remains the most common form of stroke, with a large anterior wall infarction being the major clinical correlate. The small excess of hemorrhagic strokes is usually heralded by symptoms such as nausea, vomiting, confusion, or lethargy, often progressing to coma.