Thrombolytic therapy for acute myocardial infarction: the elderly population

Coronary artery disease is the most common cause of death in persons older than 65 years. More than half of all patients hospitalized for acute myocardial infarction (AMI) are now older than 65, with this percentage expected to increase significantly in subsequent years. The current evidence regarding the treatment of AMI indicates that early thrombolytic therapy can limit the extent of myocardial necrosis, preserve left ventricular function, decrease the incidence of congestive heart failure, and reduce mortality in patients with AMI. Most studies have adhered to empiric recommendations to exclude elderly patients, based on the assumption that in the elderly the risks of serious hemorrhagic complications after thrombolytic therapy outweigh the potential benefits of early reperfusion. This article reviews the current literature regarding use of thrombolytic agents in treating AMI in the elderly population with some guidelines for protocol formation.