The Role of Fibrinolytic Therapy in the Emergency Department

Emergency physicians are many times the first-line practitioners to encounter circulatory emergencies. Amongst these many diseases we face, of importance are acute myocardial infarction, ischemic cerebrovascular accidents and pulmonary embolism. Familiarity with fibrinolytic agents and regimens, as well as indications and contraindications, are crucial to the emergency department physician. Fibrinolytic therapy has been shown to be beneficial and can serve as a bridge to definite treatment, while lowering the risk of morbidity and mortality. Unfortunately fibrinolytic therapy is underused and often administered later than optimum. The aim of fibrinolytics is to dissolve blood clots that can cause serious and potentially life-threatening damage if not removed in a timely manner. The mechanism of this benefit relates to maximizing tissue salvage by early restoration of blood flow and thereby enhancing both early and long-term survival. Older thrombi have extensive fibrin polymerization making them more resistant to thrombolysis; hence, the importance of early administration of fibrinolytic therapy.