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[Thrombolytic therapy of acute myocardial infarct in advanced age (based on 2 case reports)]
R Zweiker1, B Eber, P Kaufmann
1Abteilung für Kardiologie, Medizinische Klinik der Karl-Franzens-Universität Graz.
Insights
Elderly patients over 65 can benefit from thrombolytic therapy for acute myocardial infarction (MI). Careful observation of indications and contraindications is crucial for successful treatment in advanced age.
Area of Science:
- Cardiology
- Geriatric Medicine
Background:
- Thrombolytic therapy has significantly reduced acute myocardial infarction (MI) mortality.
- Elderly patients (over 65) show particular benefit, yet age limits are often imposed due to increased risks.
- A study in 1993 at the University Clinic of Internal Medicine, Graz, treated 54 of 181 acute MI patients with fibrinolytic drugs.
Observation:
- This paper details the successful thrombolytic management of acute MI in two male patients aged 87 and 88.
- Treatment involved 100 mg of recombinant tissue-type plasminogen activator complex.
- Successful reperfusion was indicated by rapid increases in plasma creatinine kinase and improvement in ECG changes.
Findings:
- One patient experienced minimal exertional dyspnea after four months, indicating good recovery.
- The second patient unfortunately died one month post-MI due to complications from a laparotomy for ileus.
Implications:
- Advanced age should not be an absolute contraindication for thrombolytic treatment in acute myocardial infarction.
- Careful adherence to established indications and contraindications is essential for optimizing outcomes in elderly patients receiving thrombolysis.
Abstract:
The introduction of thrombolysis has reduced the mortality of acute myocardial infarction (MI) by 25%. Large-scale studies have revealed that especially patients over 65 benefit from this therapy. Nevertheless, many centers apply an age limit for thrombolytic therapy due to the higher risk of stroke or bleeding in elderly patients. In 1993 181 patients suffering from acute MI were admitted to the intensive care unit of the University Clinic of Internal Medicine, Graz, and 54 (29.4%) of them were treated with fibrinolytic drugs. In this paper we report on the successful thrombolytic management of acute MI in two male patients (87 and 88 years old) who were treated with 100 mg recombinant tissue-type plasminogen activator complex. As a sign of successful reperfusion a rapid increase in plasma creatinine kinase levels and fast amelioration of the ischemia-related ECG changes were observed. In the follow-up examination after four months the first patients showed only minimal exertional dyspnea and was otherwise well. The second patient died one month after MI following a laparotomy for ileus. We draw the conclusion that patients of advanced age also benefit from thrombolytic treatment of acute myocardial infarction, but the indications and contraindications have to be carefully observed.