Is thrombolytic therapy effective in elderly patients?

Thrombolytic therapy (TT) is applied in patients (<75 years of age) with acute myocardial infarction (AMI) with ST-segment elevation. It is recommended for elderly patients who have percutaneous transluminal coronary angioplasty (PTCA) or bypass surgery. For PTCA and bypass surgery a cardiosurgery medical team, which can be found in large medical hospitals, has to be prepared. Patients with AMI with ST-segment elevation who are older than 75 and who do not have TT have a dubious prognosis for longevity and quality of life. The aim of this study was to propose recommendations and behavior for reperfusion with TT of the coronary arteries of elderly patients. The investigation was conducted for a period of 5 years (2000 to 2004). Investigators registered 2462 patients, 502 of whom had AMI, and 103 (54 men, 49 women) of whom were older than 75 years. Reteplase (Rapilysin, Hoffman La Roche, Switzerland) was applied to 10 patients. The general and mental state of patients as well as comorbidity were assessed. The H2- blocker Famotidine (Quamatel-Gedeon-Richter, Hungary) was used to prevent bleeding from the gastrointestinal tract. The applied TT had a positive effect on these >75-year-old patients. The oldest woman was 89 years old and the oldest man was 93. There were no complications during the treatment of these elderly patients. Aging related to serious health problems can be improved with the application of TT to elderly patients with AMI, and ST-segment elevation is an excellent reperfusion therapy. It is possible to achieve a dose reduction of the thrombolytic agent, arterial pressure no higher than 160/100 mmHg, individual risk assessment for intracranial hemorrhage, and prevention of bleeding from the gastrointestinal tract.