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Updated: May 22, 2026
05:52
Prehospital Thrombolysis: A Manual from Berlin
Published on: November 26, 2013
Future of thrombolytic therapy--an Indian context
1Poona Hospital.
Summary
For ST-elevation myocardial infarction (STEMI) in India, early pre-hospital thrombolysis with Tenectaplase/Reteplase followed by angiography within 24 hours offers a viable alternative to primary angioplasty.
Area of Science:
- Cardiology
- Emergency Medicine
- Public Health
Background:
- Primary percutaneous coronary intervention (PPCI) is superior to intravenous thrombolysis for ST-elevation myocardial infarction (STEMI).
- PPCI accessibility is limited for many STEMI patients in India due to logistical and socioeconomic factors.
- A treatment gap exists between current thrombolysis practices and ideal PPCI in India.
Purpose of the Study:
- To propose an optimized treatment strategy for STEMI in India.
- To evaluate the efficacy of a pharmaco-invasive approach as a bridge to PPCI.
- To address the challenges of widespread PPCI implementation in India.
Main Methods:
- Early/pre-hospital intravenous thrombolysis for all STEMI patients.
- Administration of direct fibrin inhibitors such as Tenectaplase and Reteplase.
- Early angiography within 3 to 24 hours following thrombolysis.
Main Results:
- The pharmaco-invasive strategy shows encouraging results in reducing acute and long-term morbidity and mortality.
- This approach bridges the gap between suboptimal thrombolysis and the ideal of PPCI.
- Successful implementation is feasible in diverse and vast settings like India.
Conclusions:
- Early/pre-hospital thrombolysis with advanced fibrin inhibitors and timely angiography is the recommended management for STEMI in India.
- This strategy offers a practical and effective solution for improving STEMI outcomes nationwide.
- Widespread adoption of this approach could significantly enhance cardiovascular care in India.
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