Myocardial infarction in the elderly: benefits and risks of thrombolytics

Patients aged 75 years and older comprise 36% of all patients with myocardial infarction and 60% of all deaths from myocardial infarction in the US. Data from randomised, placebo-controlled clinical trials and observational data demonstrated a beneficial effect of thrombolytic therapy in eligible patients with acute myocardial infarction younger than 75 years of age. The overall data support the use of thrombolytic therapy in eligible patients with acute myocardial infarction aged 75 years and older. There is an urgent need to conduct a large-scale, prospective, double-blind, randomised, placebo-controlled trial investigating the effect of thrombolytic therapy on the combined endpoint of all-cause mortality plus cerebral bleeding at hospital discharge and at long-term follow-up in eligible patients aged 75 years and older with acute myocardial infarction. Current guidelines for the care of patients with acute myocardial infarction from the American College of Cardiology/American Heart Association support the use of thrombolytic therapy in eligible patients aged 75 years and older who present within 12 hours of symptom onset of acute myocardial infarction as a Class IIa indication, that is, one for which the weight of evidence/opinion is in favour of usefulness/ efficacy. Absolute contraindications to thrombolytic therapy include prior haemorrhagic stroke, other cerebrovascular events within 1 year, active internal bleeding, known intracranial neoplasm, suspected aortic dissection, and acute pericarditis. Stroke is a potential risk of the use of thrombolytics.