[Strategies of thrombolysis in the pre-hospital phase in infarction]

In myocardial infarction thrombolysis limits the size of necrosis, preserves left ventricular function and reduces mortality. The sooner the thrombolytic agent is administered after the first symptoms, the more pronounced these favourable effects. Several studies have shown that pre-hospital thrombolysis shortens the time-lag between the first symptoms and the initiation of treatment without resulting in unacceptable complications. This method has a great therapeutic potential, but owing to the lack of randomization and to the insufficient number of patients thus treated, no study has yet demonstrated that pre-hospital thrombolysis reduces the mortality rate to a greater degree than the conventional administration of thrombolytic drugs to hospital in-patients. Pre-hospital thrombolysis is the fashion of the day. It is justified in areas with high population density but not so much in less populated areas where decentralized thrombolysis is more suitable. For this method to be generalized, mobile intensive care units conversant with the diagnosis of myocardial infarction, the treatment of its complications in the early hours and the use of thrombolytic agents must be created.