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LATE THROMBOLYTIC THERAPY MAY INCREASE RISK OF CARDIAC RUPTURE.

It is uncertain whether thrombolytic therapy benefits patients who present late after the onset of acute myocardial infarction. This meta-analysis of randomized, controlled trials suggests that late thrombolytic therapy may in fact confer added danger.

The investigators analyzed 58 episodes of cardiac rupture among 1638 patients from previous studies that met eligibility criteria. Multivariate analysis indicated that the risk of cardiac rupture with thrombolytic therapy was directly correlated with the time elapsed before treatment. For patients who were treated within seven hours, thrombolytic therapy was associated with a lower risk of rupture than that seen in controls, but this protective effect was reversed when treatment began more than 11 hours after onset of symptoms. For patients treated 17 hours after onset, the odds ratio for cardiac rupture was 3.2.

These data are consistent with the hypothesis that late administration of thrombolytic therapy may encourage hemorrhage into necrotic tissue. However, the data do not exclude a possible overall mortality benefit from late therapy, even if there is a higher risk of this serious complication.

— THL

Published in Journal Watch General Medicine August 14, 1990

Citation(s):

Honan MB et al. Cardiac rupture, mortality and the timing of thrombolytic therapy: a meta-analysis. J Am Coll Cardiol 1990 Aug 16 359-367.

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