© 2002 by Heart
EDITORIAL
Thrombolysis: too old and too young
Correspondence to:
Correspondence to:
Professor Stephen Ball, BNF Heart Research Centre at Leeds, G Floor, Leeds General Infirmary, Great George Street, Leeds LS1 3EX, UK;
cvssgb@leeds.ac.uk
Elderly patients are different from their younger counterparts when it comes to thrombolysis
Keywords: thrombolysis; coronary heart disease
Abbreviations: FTT, fibrinolytic therapy trialists; ISIS-2, second international study of infarct survival; t-PA, tissue plasminogen activator
Thrombolysis is established therapy for acute myocardial infarction. The recent National service framework for coronary heart disease1 seeks proof of its rapid delivery in all hospitals in England in the near future. Witnessing a stroke, of which the majority are fatal, after delivering a thrombolytic agent brings home to clinicians how narrow the therapeutic benefit from these agents can be. Faced with the individual patient, the prospect of minor gain against the rare potential for death or serious disability weighs heavily in decision making; doctors treat patients not populations. An article by Thiemann and colleagues2 suggested that elderly patients have nothing to gain from thrombolysis, indeed they may be harmed (fig 1
). The claims have raised an interesting debate. Can such non-randomised studies, however large the patient numbers and elegant the statistics, replace information from the randomised trial? Probably not, yet extrapolation from trials that include low risk, relatively
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This article has been cited by other articles:
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Ratcliffe, A T, Pepper, C
(2008). Thrombolysis or primary angioplasty? Reperfusion therapy for myocardial infarction in the UK. Postgrad. Med. J.
84: 73-77
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