New Challenges for Thrombolytic Therapy
Authors: David A. Tate
Journal: Annals of Internal Medicine (1989)

Editorials15 June 1989New Challenges for Thrombolytic TherapyDavid A. Tate, MD, Gregory J. Dehmer, MDDavid A. Tate, MD, Gregory J. Dehmer, MDAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-110-12-953 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptA survey of recent medical literature might suggest that the major challenges in the field of coronary thrombolysis have been met. Several large, randomized trials have now established that thrombolytic therapy not only restores coronary patency (1), but also that this restoration of patency is associated with improved left ventricular function (2) and reduced mortality (3-7). In this issue, however, Lee and colleagues (8) document in a large study what many observers and several smaller studies have previously suggested-that is, using current clinical practices only a small fraction of patients with myocardial infarction are likely to be treated with thrombolytic...References1. ChesebroKnatterudRoberts JGR. Thrombolysis in myocardial infarction (TIMI) trial, phase 1: a comparison between intravenous plasminogen activator and intravenous streptokinase. Circulation. 1987;76:142-54. CrossrefMedlineGoogle Scholar2. O'RourkeBaronKeogh MDA. Limitation of myocardial infarction by early infusion of recombinant tissue-type plasminogen activator. Circulation. 1988;77:1311-5. CrossrefMedlineGoogle Scholar3. Effectiveness of intravenous thrombolytic treatment in acute myocardial infarction. Gruppo Italiano per lo studio della Streptochinasi nell'infarto Miocardico (GISSI). Lancet. 1986;1:397-402. MedlineGoogle Scholar4. WilcoxVan der LippeOlsson RGC. Trial of tissue plasminogen activator for mortality reduction in acute myocardial infarction: Anglo-Scandinavian Study of Early Thrombolysis (ASSET). Lancet. 1988;2:525-30. CrossrefMedlineGoogle Scholar5. Van de WerfArnold FA. Intravenous tissue plasminogen activator and size of infarct, left ventricular function, and survival in acute myocardial infarction. Br Med J. 1988;297:1374-9. CrossrefMedlineGoogle Scholar6. Effect of intravenous APSAC on mortality after acute myocardial infarction: preliminary report of a placebo-controlled clinical trial. Lancet. 1988;1:545-9. MedlineGoogle Scholar7. Randomised trial of intravenous streptokinase, oral aspirin, both, or neither among 17,187 cases of suspected acute myocardial infarction: ISIS-2. (Second International Study of Infarct Survival) Collaborative Group. Lancet. 1988;2:349-60. MedlineGoogle Scholar8. LeeWeisbergBrandRouanGoldman TMDGL. Candidates for thrombolysis among emergency room patients with acute chest pain: potential true- and false-positive rates. Ann Intern Med. 1989;110:957-962. LinkGoogle Scholar9. MurrayLyonsLaytonBalcon NJCR. What proportion of patients with myocardial infarction are suitable for thrombolysis? Br Heart J. 1987;57:144-7. CrossrefMedlineGoogle Scholar10. DooreyMichelsonWeberDreifus AEFL. Thrombolytic therapy of acute myocardial infarction: emerging challenges of implementation. J Am Coll Cardiol. 1987;10:1357-60. CrossrefMedlineGoogle Scholar11. HlatkyCotugnoO'ConnorMarkPryorCaliff MHCDDR. Adoption of thrombolytic therapy in the management of acute myocardial infarction. Am J Cardiol. 1988;61:510-4. CrossrefMedlineGoogle Scholar12. Annual summary of births, marriages, divorces, and deaths. United States 1985. National Center for Health Statistics. Monthly Vital Statistics Report Vol. 34: No. 13, DHHS. Pub. No. (PHS) 186-1120. Public Health Service, Hyattsville, MD, 19 September 1986. Google Scholar13. JaggerMurrayDaviesLittlerFlint JRMWE. Eligibility for thrombolytic therapy in acute myocardial infarction. Lancet. 1987;1:34-5. CrossrefMedlineGoogle Scholar14. RoweSimpsonTate WRD. Non-emergent cardiac catheterization and risk-stratified revascularization following thrombolytic therapy for acute myocardial infarction: a critical analysis of therapy in the community setting. Arch Intern Med. 1989 (In press). CrossrefMedlineGoogle Scholar15. TopolBatesWalton EEJ. Community hospital administration of intravenous tissue plasminogen activator in acute myocardial infarction: improved timing, thrombolytic efficacy and ventricular function. J Am Coll Cardiol. 1987;10:1173-7. CrossrefMedlineGoogle Scholar16. TateRoweSimpsonNicholsGettes DWRTL. Coronary thrombolysis in rural hospitals [Letter]. South Med J. 1989; 82:95. CrossrefMedlineGoogle Scholar17. Coronary thrombolysis and myocardial salvage by tissue plasminogen activator given up to 4 hours after onset of myocardial infarction. National Heart Foundation of Australia Coronary Thrombolysis Group. Lancet. 1988;1:203-8. MedlineGoogle Scholar18. WhiteNorrisBrown HRM. Effect of intravenous streptokinase on left ventricular function and early survival after acute myocardial infarction. N Engl J Med. 1987;317:850-5. CrossrefMedlineGoogle Scholar19. FletcherFletcherWagner RSE. Clinical Epidemiology: The Essentials, 2nd ed. Baltimore: Williams and Wilkins; 1988:132-3. Google Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: North Carolina Memorial Hospital Chapel Hill, North Carolina Nextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited ByMolecular Mechanisms in the Pathogenesis and Treatment of Acute Ischemic StrokeGuidelines on how to assess the validity of results presented in subgroup analysis of clinical trialsMinimizing the risk of inappropriately administering thrombolytic therapy (Thrombolysis and Angioplasty in Myocardial Infarction [TAMI] study group)A Consumer's Guide to Subgroup AnalysesAndrew D. Oxman, MD, Gordon H. Guyatt, MDPsychological factors related to prehospital delay during acute myocardial infarction.Wider Inclusion Criteria Needed for Thrombolytic TherapyRichard Peto, MA, MSc, Rory Collins, MBBS, Peter Sleight, MD, DM 15 June 1989Volume 110, Issue 12Page: 953-955KeywordsMortalityMuscular dystrophiesMyocardial infarctionRandomized trials Issue Published: 15 June 1989 PDF DownloadLoading ...