Incidence of vascular stroke in patients with acute myocardial infarction receiving fibrinolytic treatment

Aims The benefits of fibrinolytic therapy in reducing mortality of patients with suspected acute myocardial infarction (AMI) are well established. The extent to which fibrinolytic therapy is also associated with an increased incidence of haemorrhagic stroke required investigation. Methods and results A subgroup analysis of the TIM (Triflusal In Myocardial infarction) study was carried out in patients who had undergone fibrinolytic treatment, to establish the effect of antiplatelet agents upon the incidence of stroke. Seventy per cent of 2275 patients with AMI, randomized to receive 600 mg of triflusal or 300 mg of aspirin once daily for 35 days, received fibrinolytic therapy. Nineteen patients (1.3%) receiving fibrinolytic treatment suffered strokes during the treatment period. The incidence of stroke was significantly lower for patients treated with r-tPA and triflusal compared with those receiving r-tPA plus aspirin (P=0.03). This finding was attributed to a reduced incidence of haemorrhagic strokes in the triflusal group (0% vs 1.6% in the aspirin group; P=0.01). No significant difference in total stroke incidence, or in the incidence of haemorrhagic stroke, was observed between triflusal and aspirin when either agent was administered in addition to streptokinase treatment. Conclusion The results suggest that triflusal may be associated with a lower rate of haemorrhagic stroke in patients receiving fibrinolytic therapy with r-tPA.